Doctor of the Fallen Turtles: Kratie Province Cambodia 1994

I can still see it. The great clay green waters stretching like a slowly moving ocean. The tooth-like jagged rocks puncturing the surface as though some giant had scattered a pepper shaker of molten larva into the waters eons ago and the huge green islands basking in sun-warmed languor under the dusty sky of a Cambodian dry season day. Some time in the future there will be tourist hotels here and bars and swimming pools and stalls selling trinkets and handicrafts. But now there is just the rustle of the wind in the sugar-palm trees, the whack of small boy driving a water-buffalo to the river and the humming background chirp of a crickets.

And here in this small patch of dangerous paradise works a remarkable doctor. She is in her early 30's, dark haired and graceful in her step as she moves softly between the raised wooden houses of the small riverside village a small notebook in her hand. She wears around her waist the coloured kromma of the Khmer, and she speaks in their language to the people who come to greet her. Yet her skin is white and her dress of western style. Now and then she pauses to bend and put a comforting arm around a small child while the other lightly yet expertly assess the full curve of its protruding tummy. Then she rises to make a small note in her book while the children, unafraid stare at her with their big liquid eyes and smile.

To some of the children it is all part of a game, bu Dr. Sophie Biays and the people of the river well know otherwise. For this is the land of the 'Fallen Turtle Disease' which swells children's stomachs and causes them to vomit blood until they can take no more. Old belief by some was that a turtle had fallen down inside the belly. Others considered the culprit was a bees nest. To Westerners it is known as Schistosomiasis.

For the people who live beside the Mekong it is their life. They drink its waters, use them as their source of refuge on in the relentlessly long afternoons of the hot season, wash in them, fish them, are carried by them in their small wooden boats and use them to transport the great jungle logs that they cut to be sold to eager traders from Thailand, Malaysia and Singapore.

Yet it is in these very waters that the fallen turtle disease lurks and is maintained by an unlikely creature; a tiny water snail, the largest of which are no bigger than a shirt button. The snails live on and under rocks and hence thrive in this area of the Mekong. Known as the 'Sambo Rapids', there are no real rapids in the normal sense of the word. Rather it is an area where for some primordial geological reason, the normal mud and earth bed of the river gives way to a structure predominantly of rocks and stones. As you run your eye across the glistening water great jagged icebergs of stone rise from the surface like dragons teeth and small swirls indicate boulders lying just below.

Until the French administration mapped out and marked a usable channel in the 1940's navigation through the area was a risky business. Now the large cement markers still stand, one of the very few remnants of the colonial era left untouched by the Cambodian holocaust of the 1970's.

The snails themselves are not the culprits, simply an inadvertent intermediate vehicle for one of the stages in the infection cycle of the miniscule blood 'fluke', a type of tiny short worm, which is responsible for the disease. After a gestation in the infected snail the organism is released as a tiny, torpedo shaped form known as a ceracria. The cercariae swim freely but will bore through any human or animal skin which has entered the water in their vicinity. Once inside the body, the organism changes shape and migrates to the veins around the liver and stomach. There the flukes mate and produce eggs. Of social interest in these days of increasing broken marriages it is interesting to note that the male and female schistosome mate for life. The longitudinally grooved male wraps his body around the cylindrical female to spend their days affectionately locked together as one egg producing unit.

It is not the adult flukes but the eggs which cause the long term damage. They excite inflammatory and immune reactions which block vessels and cause massive enlargement of the spleen and liver which will often lead to complications and death. Some eggs however will find their way through the intestinal wall and be excreted with the faeces. If the faeces are deposited near the river and are not treated the next rain storm will wash the eggs back into the river where they hatch into yet another form. And this form, the miricidium, penetrates the water snail to comple the cycle..

Dr Biays speaks with the soft accent of her native Brittany. She tells me modestly that the disease in Cambodia had been discovered years before and that her project was simply a continuation. The enormity of this understatement makes me smile. Although it was certainly recorded in the mid 1960's the almost umimaginable holocaust of the Marxist 'Khmer Rouge' overthro of the government ten years later resulted, along with the deaths of three million people, in the total destruction of almost every record of every fact in the country. The Khmer Rouge themselves appropriately referred to the start of their regime as 'year Zero', and set out to remould society comletely from a beginning wiped clean all local links with its past.

And within bloodshed and the destruction, the forced labour and the so called 're-education camps', later found to be basic extermination camps, the fallen turtle disease of the river and its sufferers were simply carried along in the juggernaut of horror. Their disease had been forgotten about and their lives hung like the others only on tiny threads of chance. For a smile or a tear at the wrong time was not permitted, a word or silence when it was not appropriate could mean a sentence of execution.

So when the UN men in the blue caps followed in the NGO workers so fifteen years later, they found a country almost totally devoid of any fabric of infrastructure or historical record. They found a people shattered, confused and shocked, and evrerywhre, the crumbling aftermath of mass distruction.

And into this vortex of disoriented confusion came Dr Biays, her job arranged through an NGO to assist the National Malariology Department in the capital, Phnom Penh to re-establish its role within the country. This meant regular field trips and one of these took her to the Sambo District of the Mekong.

'I was shown some "bad cases of malaria"' she said. 'Well, they do have malaria here and it does give enlargement of the spleen and liver.. but these cases seemed just too largd... I was suspicious ... I came back and took samples..'

So, far up the Cambodian Mekong Dr.Sophie Biays rediscovered Shistosomiasis. She realized immediately that there was a desperate problem. Medical services in traumaitzed rural Cambodia were in an almost totally non-functioning condition and even where help might be available, the disease was being wrongly diagnosed as Malaria, for which the treatment was entirely different. But she knew also that there was hope. Her training in Tropical Medicine had given her the knowledge that there was a cure and what was more, that it was close to 100% effective, could be given in just one dose - an enormously important point for treatment compliance. Developed originally for the lucrative vetinary world, the drug Praziquantel had to wait several more years before anyone was prepared to spent the money to carry out the necessary trials for human use. The sad fact is that the humnan pharmaceutical industry well knows there is little money to be made in developing countries where such diseases tend to lie. Eventually however the World Health Organization agreed to subsidize the trials, and a human wonder drug was borne.

But Praziquantel is relatively expensive and Dr Biays knew that if she were to start a treatment program, she would need help. And the help came from the Dutch/Belgian/Swiss branch of the NGO Organization Medicins Sans Frontieres, one of the most effective in the world. They not only agreed to sponsor Dr Biay's program but also to put her in charge and assist in building a small district hospital for the area. Early in 1984 Dr Biays bumped up the potholed hour and a half access road, moved into her small wooden house in Sambo Village and started work.

Few others would have. For in the dark brooding forests of Cambodia, the men of death, the Khmer Rouge guerillas, still lurk, moving silently into the villages at dusk or nightime to take food or money from the inhabitants. In the daytime they melt back into the forest but from their jungle bases manage the logging trade by taxing those who come to cut wood. Mainly without roads and largely ignored by their own governmment except by corrupt officials after the same lumber taxes, the villages of Sambo live in a semi- autonimous shaddow land of alleigance, bending theis way and that depending on who is making demands on them. No one, not even the villagers themselves, know when the Khemer Rouge will turn up, and neither does Dr. Biays. 'I have been lucky' she says. 'No problems so far, although there three full time Khmer Rouge villages we cant get to'

Yet there were problems, twice. In late 1994 when there was a flare up in fighting MSF had to pull Dr Biays and her team out for three weeks, and later, perhaps more seriously, she narrowly avoided being kidnapped at the time when the Khmer Rouge we looking for Western hostage. Dr.Biays had been held up by work-load in the small clinic that day and cancelled plans for a district visit. She later heard that on the road she had intended to travel, every passer by had been stopped by Khmer Rouge soldiers looking for Westerners. Of the seven that they did end up in taking in several episodes over those weeks, only one survived.

In the height of the dry season, the heat is intense. From middy to around 4pm it becomes almost unbearable as the land sweats and swelters under an apoplectic Cambodian sun. Only the tall sugar palms with their neat green haircuts seem to stand up to intensity. Yet on the doorstep of Sambo village runs the great river, its waters now low but softly calling a cool invitation to all those who are within earshot. And the buffalo and the children are the first to accept, the former wallowing happily their horned heads only visible like a cluster of Viking helmets thrown overboard by some ancient raiding party, while the latter in contrast jump and roister in a flurry of splashy antics which bring smiles to the fishermen and log cutters labouring on the sandy bank.

But it is in the dry season when schistosomiasis transmission is the highest. Then the water flow is slow and the low level brings the rocky habitats of the aquatic snail close to the surface. In their free time, the children are almost constantly in the water but to try and change this lifestyle of a thousand years or more would have been almost an impossibility.

Dr Biays knew that she had to concentrate on the children. It was the children that the 'Fallen Turtle Disease' effected most severely and where the greatest suffering and death occurred. Travelling around the villages she could see whole families where every child was effected, many to a horrifying degree of severity and some close to the end.

My visit to Sambo was almost a year after Dr. Biays had started her work. In that time, with almost limitless energy she had time

systematically screened and treated the children of almost every village in the area. Like some tropical Florence Nightingale,

Everywhere we went we would be greeted by children and their grateful parents. Time and again she would point out to me a

child in the process of reverting to health under the effect of the drug or those who had ben completely cured. Amazingly she

seemed to know every one by name and I could see her overwhelming pleasure in their happiness. 'I love my work' she said,

and I believed her.

26 November 2005 - Kalmunai
SriLankan Hoop Dreams

Dreams are a wonderful thing---they come in all shapes and sizes. We thought that basketball in SriLanka was a pipedream but we were wrong. It was probably Charles’ wildest dream that he would conduct a basketball clinic in Kalmunai!

It all started when Reverend Brother Stephen Matthew, the principal of Carmel Fatima school decided to show Charles and I the school basketball court. It was covered with sand and full of potholes with two aging wooden backboards and no nets. All things are possible! The next day we drove to Batticaloa with the priest in his long white robes to visit the bishop. The bishop was a good natured soul who wanted to see the Kalmunai boys beat the St. Michael’s boys at Batticaloa. These Batti boys are the reigning champions although it is difficult to understand who else they have ever played against. It seems that St. Michael’s has the only other basketball court in eastern SriLanka. In any case the bishop blessed us and sent us on our way.

We went next to visit the famous St. Michael’s school and the sports coach showed us their courts. These weren’t just courts---they had an entire stadium with custom backboards, real stands and a digital scoreboard. Apparently, one of the Jesuit priests at this school many moons ago was an American from Pennsylvania who is famous for introducing the game to the island. Not to be put off by this kind of competitive display, Charles and the priest went to a tiny sports store to buy nets and basketballs.

The first practice was hilarious. The nets we bought didn’t fit because they were net ball nets (which the girls play) and they are smaller, although the sealed package clearly stated they were basketball nets. Now we got out the netball nets that were too big for the netball hoops and they were the right size for the basketball hoops, but the hoops didn’t have any hooks for the nets to attach to, so the sports coach sent one of the boys to get some skotch tape. He climbed up on a rickety student’s chair on top of a rickety student’s desk and proceeded to skotch tape the net to the hoop.

And then the boys showed up! They were the cutest little 9 and 10 year olds in their little school uniforms and many of them had bare feet, the skinniest little brown legs I have ever seen and they all had crooked ties and shirt tails hanging out and big smiles on their faces , although they did look a little frightened of Charles. The practice was a sort of disorganized confusion as Charles told them what to do in English and the school coach translated into Tamil with his limited knowledge of English and Charles complete inability to speak even one word of Tamil. I wish I had it on film. The boys were so incoordinated, happily bumping into each other, laughing, balls were bouncing off their heads and mayhem was everywhere. Before the session was over however, they had figured out how to line up and imitate Charles and that that the object of the game was to throw the ball in the basket, not at each other. This led to an unfortunate incident when one of the boys actually hit the hoop with his ball and the backboard, the hoop and the net came tumbling down off the pole. Luckily not one child was hurt and a big laugh was shared by all.

So, now they have a basketball court with one hoop and potholes full of puddles and 20 little boys with big dreams of someday beating St. Michael’s, but hope springs eternal in this amazing place. Twenty four boys came out to the next practice. When we mentioned that they were beginning to look like young Michael Jordans, they said, “ Who is Michael Jordan?”
I love these kids! Such are the hoop dreams of post tsunami Kalmunai, SriLanka. After all we do have the bishop’s blessings---

Life is beautiful during the Rainy ‘Monsoon’ season.It’s ever changing from one exteme to another. We leave our shoes outside the Hotel and hope they are dry the following morning, as the rain comes and goes in rages amd burst.We’re hoping to become more adventuresome but the climate remains tense and the roads to the South are closed as the election fallout continues. Apparently the story is that the canidates that lost the election by a slim margin are punishing this particular Muslim community for not casting any votes.
We did spend a day on the road travelling in a van about 40 kms to the town of Batticalao.
We saw more areas affected by the Tsunami and visited schools along the way.We also did some shopping for basketball equipment,as I conducted my first Basketball Clinic yesterday with a group of 20 nine and ten year olds.Some practiced in bare feet and they seemed to enjoy this introduction to the game,which is quite popular ,to my surprise.In Sri Lanka time is dealth with much as it is in the West Indies.Being an hour late is no big thing and events are often postponed to the next day without warning or ceremony. The one exception to this trend is the Carmel Fatima school.This is the largest school in Kalmunai and is run by the priest and nuns.They operate on a strict timetable and emphasize the word ‘sharp’when they state what time an event is going to take place.We arrived at Carmel Fatima school this morning to the sounds of Jingle Bells being player on the PA system.It brought instant smiles to our faces and Gail commented on the playing of these tunes during a speech she gave to the assembly of students while making an awards presentation.
We are becoming more familar to the townsfolk, but Gail is clearly the biggest attraction with her fair skin and blue eyes.The school age girls can’t help showing their excitment once they spot Gail. Our time is growing short in Sri Lanka and there still is so much that is needed to do.

All the Best

Gail and Charles aka Abbas

Greeting from Sri lanka friends and relativesThe days are moving slowly, with minimal activity dueto the Shut Down following the elections.The mood is grim as the Opposition Party failed in its attempt to overthrow the Government in power.Therefore the possibilities of a solutions to the twenty years plus of civil conflict appears remote.Gail and I are settling in to a rountine of waking up late and spending the day at the AMDA/Rose Charities office.The resolve of the team there is amazing, led by former Surrey resident Antony Richard, A Sri Lankan born immigrant to Canada.Though the days are moving slowly we do have to adjust to some fast moving mosquitoes.They are quite small but pack a whallop.The food situation is another majoradjustment and we are using the less is more approach presently.The good news is that we both get very busy on Monday.Gail will begin further training with the counsellors while I embark on a series of basketball training clinics.We have met many our the teachers but still get the sense that the community is very divided.There has been much tension in the muslim section of town since an explosion which took place outside the mosque early Friday. The goings on of the outside world is rapiding fading as it is extremely difficult to access the news.The weather continues to be overcast with an occasional burst of sunshine ,which reminds all how hot it would be without the cloud cover.There was a brief rain today which was momentarily refreshing.With the best wishes to allGail and Charles aka Abbas
TROUBLE IN PARADISE The recurring sound of gunshots throughout the day has driven me to a mildly hypomanic state. I feel the overwhelming desire to comment on the humour of our journey here. I recall that when Charles and I were traveling in South Africa at the time of the White referendum vote, we were constantly befuddled at how everything worked backwards----the water even went down the drain inth opposite direction. In this township in eastern Sri Lanka it is quite different-----it just doesnt work at all. The little family-run hotel that we are staying in is a case in point. The SuperStar Hotel-----yes Super Star-----is the Sri Lankan version of Faulty Towers, the British comedy series starring John Cleese. h On our first night here we arrived around midnight having been delayed by so many military checkpoints and detours. The gates were locked for the night and we had to honk our horn, shake the metal gate, yell loudly, flash our headlights, raise all the dogs in the neighourhood and generally be as obnoxious as possible.We asked for a room with a double bed and were cheerfully escorted to a spartan room with two double beds and a single bed. Our first morning we asked for coffee and they brought us a tiny empty bottle of instant Nescafe with some lukewarm water. We asked for bread and they said, Sorry sir, we have no bread. When we asked what they did have for breakfast they said Stringhoppers sir. Now, we are in a very foreign place and ,to us ,the breakfast sounded like skinny grasshoppers, so we chose not to eat. That evening we returned to the SuperStar for dinner. When we asked what they had for dinner they said, Fried Rice. When we asked what else they had, they said, Fried Rice with chicken and Fried Rice with fish. When we asked whether they had anything else, they said, Yes, we have Fried Rice with p rawns. We decided on fried rice with prawns and they returned moments later to say, Sorry sir, we have no prawns. I said I would have chicken and Charles said he would have fish. When dinner arrived we each had a giant pile of fried rice. Mine tasted like fish and Charles tasted like fish, although we could find no chicken or fish in either. I ate two spoonfuls. We had laundry that needed washing and there is a washig machine here. When we asked if we could do laundry, they said, Sorry sir there is no water. Our telephone doesnt work. Our lights go out quite regularly---thank heaven we brought a flashlight! Charles has become the great brown hunter of mosquitoes in our room---I think we kept the whole hotel up last night whacking the ceiling and walls with wet towels and rubber thongs. Did I mention, however, that we are the only guests in the hotel?There were two Chinese couples who were tourists from Hong Kong who were staying here two nights ago---go figure! I know it sounds like we do a lot of communicating with these people, but, honestly, we have decided that they dont understand a single word we have spoken since we have arrived here. Charles just went downstairs to use the telephone because if you remember we only have a mock telephone in our room. He called Anthony to find out how to use the adaptor to get the antiquated laptop to work. On his return, Charles says there are six people watching a cricket match on television between Soth Africa and India, broadcast in Tamil. He also reports that there is one baby salamander and an army of mosquitoes lined up outside our room, waiting to come in. Did he find out how to use the adaptor---its really quite simple.You put two prongs in the bottom two holes on the wall and you put a ballpoint pen in the large top hole and the whole thing works.Oops! I see sparks coming from the ball point pen. Annie, annie, can you hear me? I shake Charles and we both laugh. The final irony in all of this---our sweet young translator, Mercy, asks if we are comfortable in our hotel. We answer, Yes. She replies, That is good. It is the finest hotel in all of Kalmunai
Basketball 101 Sri Lanka Aim and Objective: To provide a recreational outlet to children living in stressful a environment To promote a sense of pride and accomplishmentTo stress the importance of teamwork and co-operationTo promote a positive self imageTo promote sportsmanship and fair play Agenda Items to be covered during the Clinics: -The philosophy of basketball-Any Team can defeat any other team on a given day eg. US Olympic teams of NBA -Skill training Triple Threat position Lay-Up Drills..1-2-2 offence positions-both hands Shooting philosophy and technique Defensive philosophy and stance Passing Drills: Chest Bounce Baseball Tap Drill and Rebounding Outlet passing Defences-man to man---zone Shooting Game

19th November 2005… Kalmunai Sri Lanka
ONE SOLITUDE

There are not two solitudes in SriLanka---only one---and it is the Tamil region of SriLanka. Charles and Anthony and I drove across the island from the comfort of our Colombo Hotel to Kalmunai. It was quite a magical trip at the beginning---driving through the Sinhalese countryside with it’s lush farms and mountains and jungles. We saw an elephant by the roadside! The villages were lively and happy. As dark began to fall and we reached the east coast, the military presence began to be felt---a very different SriLanka than the one occupied by world aid organizations in May.

The military checkpoints became more and more frequent, the barbed wire was all around us, the special forces units were heavily armed and dressed in camouflage gear, the roads were blocked and replaced by almost impassable detours. Close to Kalmunai the very young forces began to look very anxious---a sign to me that they they might become trigger happy at the slightest provocation. The streets were deserted and dark---a curfew was in effect.

Along the way there had been so many other roadside attractions---beautiful little shrines everywhere---more frequent even than the military. There was Ganesh, the Hindu god of the traveller, Budda looking serene and peaceful, sometimes Jesus and sometimes Mary depending on which church you attend, and attractive Muslim mosques. I turned to Charles and made some innane comment about the religious faiths not practicing the peace and love that they preach. I guess this trip has been Religion 202 for me---a lesson about the differences and not the blessings.

Today is election day and the entire town is closed down. If you are not going to vote you stay home. As we were discussing plans for the kids here in Kalmunai with Anthony, there was the sound of an explosion. Anthony told the counsellors to be calm and that it was probably nothing. A little later one of the school principals came by to tell us that a bomb had exploded in a nearby residential neighbourhood killing one young man and two children and injuring others who had been taken to the hospital next to our house. The news shocked me however, as the principal told us that the man who had been killed was the son of Loga, the local nurse who was part of our team on my trip to Kalmunai in May. I had met her whole family at that time when we had tea in her home. Loga was a part of our daily life in Kalmunai and my heart is aching for her tonight---anf for the families of the two children. There have already been too many tears in Kalmunai!

Gail and Charles Belcher


17th November 2005 – Sri Lanka
HAPPY AS CLAMS


“ Love consists of this: that two solitudes reach out and greet and touch and protect one another---”
Yeats?

Two Solitudes
( from the Canadian novel about the tensions between French and English society in the 1930s---can’t remember all the details or the exact quote but the concept keeps coming to my fading mind---I loved this book---early Canlit)

Part 1 Day 1
Charles and I have spent our first day in SriLanka at the posh Mount Lavinia Hotel south of Colombo. I have been seduced by this island again. It is an island drunk with the nectar and buzz of all things living---the rolling of the sea, the depth of the colours, the tintillating spices of the food and the intoxicating scent of plumeria on our pillows as we fall into a deep, delicious sleep---the sleep of children.

Part 2 Day 2
We have had lunch beside the sea. We are sitting on the pool deck of our hotel following a refreshing swim. We are chatting about litle things. A cracking noise breaks the stillness of the moment. It is a sound repeated again and again.

We all try to ignore it. We want this bliss to continue. The unmistakable sound of gunshots continues and we all begin to look along the beach towards the city. We see smoke. It is coming from the Tamil suburb of Colombo. It looks like the smoke from an an explosion and the gunfire continues. It is a harsh reminder that there is an election in two days and that the Sinhalese and the Tamils have been at war for over twenty years. Theirs is an uncertain peace. Today we are in Sinhalese territory. Tomorrow we will travel across the island into the poverty of Tamil territory. Peace is elusive. Life is fragile. This is truly an island of two solitudes.


PS. I am reminded that only yesterday I wrote an email home to Canada. I signed it---” Happy as clams in paradise.” It is a tenuous paradise.


17 November 2005 CAMBODIA and elsewhere…

Many months since anyone has written on this page. They have been months of rush and build, plan and push. Things go forward on so many fronts and its hard to say which has progressed further. Sri Lanka, Cambodia in the field and NZ, Australia and the USA in the network are all moving forward at a great pace. Rose-AMDA Canada has just hosted the 19th International AMDA Conference in Kuala Lumpur. AMDA Canada and Rose Charities Canada are, of course run tightly together in B.C. with AMDA being the organization which organizes our emergency relief, leaving Rose Charities to concentrate on the long-term sustained projects. The conference was a great success with guests of honour being Ms Rachael Bedlington, Head of International Affairs from the Canadian High Commission to Malaysian, and Colonel Khor, Director of the Medical Division of Civil Defense Malaysia. An AMDA Malaysia Chapter was formed with Colonel Khor agreeing to be a member. The setting in the harmony of Malaysia, and Malaysia is truly a harmonious country - with much I think to teach the world in this area.


Up in Cambodia we will be reaching our 10,000 th operation this year. These are predominantly eye operations, and most of those sight restoration / blindness prevention. And almost all of the eye operations have been carried out by Dr Vra. Dr Vra deserves a medal. His determination is amazing. Even after all his equipment, fittings furniture, vehicle(s) even garden plants, had been looted by (expatriate) crooks three years ago, he would still turn up at his empty shell of a clinic to see what he could do to help patients. Now, he has made Rose Charities Cambodia significantly the most functional Cambodian run health facility in the Country, building up from his catastrophic loss to a state again where he operates on around 2000 impoverished Cambodians per year, and sees 8 to 10 times that number in his consultation room.

Operation Rainbow, a B.C cleft palate and child surgery team visited our other Cambodian center (Dr Saroms First-Rose) center and Chea Chumnas hospital in October. They had planned to carry out around 40 operations, but ended up doing 90. It is a good, honest, charitable and generous organization and we at Rose are very happy to be partnering with them..


ARCHIVED BELOW FROM MARCH 2005 - TSUNAMI NOTES SRI LANKA

Yaya 9th March 05

Interventions

A few children said they were in shock during the Tsun. And in fact 4 of the group reported being under water and struggling to be alive. 4 of them had their house destroyed but now are living with relatives. 17 reported being distressed by the sight of many dead bodies, and one told he always see his best friend, whom he saw dead.


In this first session I used a clinical inventory regarding post traumatic stress signs, and coincident with the existing literature, the adolescents described their problems as follows: (statistics are high and will be later reported)

Also it is important that we realize that there are confounded variables, triggers and contextual factors such as the on going social instability and violence in the area (before the Tsu), and the concerns these good student have that they are failing and may not pass the final exam. In a sense they seem worried about the past, and certainly one can see its impact, but also their future. In order of highest to lowest percentage (75% reported memory difficulties while 8% feel guilty for being alive.


- problems to remember material and can't study or recall as before
- difficulties concentrating while reading, in class
- feel unhappy, more nervous, more anxious, depressed sometimes
- has a sense of uncertainty
- don't trust much, hypervigilant, startled easily
- get mad when people talk about Tsun.
- apathetic and not as interested in activities as before
- pain such as headaches, shoulder, stomach
- more angry, more frequently
- scary images and thoughts popping in the mind
- feels guilty


Interventions


The first session was successful according to reported feed back.


Their teachers will meet tomorrow and I intent to point out the importance not only for them to become models in class (calming down through breathing, providing breaks, helping them to "mirror" learning with a friend, etc.).

I was given a newspaper (The Island from Colombo) in which Prof. Dr. M. Thiruvanakarasu, a leader of the medical delegation arrived on a training program for health workers. He pointed out in the article that not only those directly affected by the Tsu and who lived in the area most affected has suffered its impact but all. The injury of the mind is important and must be healed properly.


It is a convincing small article and he predicts that 3 to 6 months is a good time for people to assess and help with healing. If help is not provided, long lasting impact and more complex, chronic mental health needs will appear.


The most important is routine, as well as the ability of medical professionals identify and refer to counseling services.

It was reassuring to see that our plans with the Rose Children Center is not a western model, but something that we all (around the world) are learning - we must address psycho social needs of children, families and communities, even though I am aware that there is a long and difficult history of violence, violations, etc.

Yaya 9th March 05


yesterday, the surgeon from the hospital called me at his home and expressed some concern about our safety. apparently there was some demonstration in town and he was afraid of what would or could happen... evidently these occurrences have happened in the past and people died, and after a couple of days everything is fine. so, we decided to sit and wait.


in the afternoon I went for a bike ride and everything was quiet. they close the city during the day, but there was no fights, only some kind of speech from the people who want to come back and build their homes in the original place - nearby the beach, and they are not being permitted...


it is interesting to see that a house was fixed there, and it call - tsunami guest house. I am sure it will be in the lonely planet book, and there is arrangement to something else be fixed - which will become a bar. bad decisions in my view, but, I don't know how people make city planning decisions here.

the work is great, yesterday I had 36 students from grade 13 and all was fine. they made great drawings and we laughed and they told me about the hunting images that pop into their minds from nowhere... about the dead people they saw after the tsunami.


these kids have lived a variety of great stressors, before the tsunami and one cannot avoid to think that they have resilience and go on living, as all of us, despite many things around.

so, the house is fine, today I woke up very early and took my bike to town and bought a fresh bread that was eaten immediately by all - and I made toast on the stove and it was delicious. ah, if we only had way to make a real cup of coffee. so far it is instant coffee with powder milk, not very appealing to me, but I also got condensed milk, and it is very nice with tea.

the food is also very nice, and I am teaching the cooks to make garlic mashed potatoes. imagine, and yesterday they had this great bread like, fried chappati or something like that and a delicious chicken. also we found a wonderful papaya and so, we all are happy.

keep well, in peace and in love with all and life
namu amida bu

Yaya 10th March 05

..just a brief hello in the middle of the day. I am in a sort of break. the house is empty and I will be back working in 5 minutes or so, but could not resist to read emails.

everything is fine. you can trust our responsible leader . and count on the individual sense of responsibility and safety. but we are fine, really. aware and careful, but safe.

the program at school is getting better every day. imagine that today there were 43 children and in the beginning of the session a boy (all grade 12 and 13 - we started with the older ones) stood up and said he thought some other few kids should join us and here thet come, a batch of more than 10 we did not think would be interested. they are far from my experience in any high school in vancouver. they are polite, quiet and listen with great attention (to my english and the interpretation). it is a delight to be here.


they knod their head when I talked about possible normal reactions and certainly raise their hands. the statistics are high, and in a way I am happy that I knew they would report post traumatic stress, even someone would ask him specifics. also, they are enjoying the healing tasks, and a group of teachers today decided they will do some exercises in class, and become models (I tried to convince them that workers care is as important as good teaching....) anyway, the high light of the day was that the PE teacher said he would come with me and a group of children (we will choose carefully) to the ocean and exercise breathing and taking control again of AALI (the ocean) and everybody laughs sure... as I throw one single word I learn...


also, tell mike that the garden is in place, as he knows and I would like to suggest the kids to bring rocks to put around in 2 layers (like a path, as I told you in vancouver) and they could write their names or paint faces, or whatever they want, and in the future they would come and walk around and identify their contribution to it. the school said they would arrange for such an event.


and we could also make an event in which the kids would "" print" their hands on the wall - it is a beautiful blue and it would be an artistic playful scene to see the hands of children on the walls. perhaps diana could do something like that when she is here…


Josephine 10th March 2005

Thank you for your email. I am glad things are quiet. we were all sitting yesterday in a Steering committee meeting ...thw whole team.!!!when the phone rang and it was Dr Bagawan saying it was not safe...so the meeting ended in high drama and we rushed about and tried to get you all evacuated to Columbo..and perhaps luckily...the road was closed ...so that was that. I was worried for you all but also sort of glad that your wonderful work was not interrupted...but please stay safe…

Josephine 12th March 05

Over 10,000 people were killed by the tsunami in the area around Kalmunai on the East Coast if Sri Lanka. Many of them were the mothers and young children who were at home when the Tsunami struck and devastated a 3 km band of coastline.

Two weeks ago the schools reopened and faced the daunting task of trying to provide some stability and healing for the children. Many of these children have lost parents, siblings, best friends and pets. They have lost their homes and are living in one room makeshift shelters or tents. There is nowhere for the older children to study for their exams. They have lost their school uniforms, their bicycle to ride to school, their pens and books. Some of their teachers are dead and others have lost their own families. There are no counseling facilities in any of the schools

Dr Yaya de Andrade arrived in Kalmunai at the beginning of March with the mandate to assess and increase our counseling program. We already had a Saturday morning clinic for traumatized children but felt that this was inadequate to meet the urgent needs of the children. After 2 days of assessment Yaya has selected a school to act as a pilot project. The school has approx 2000 pupils who have been severely affected by the Tsunami Our field coordinator, Anthony Richards recruited 12 local volunteers interested in assisting with counseling. They had experience ranging from an 8 months diploma course to one 3-hour training session. All were prepared to work and very motivated.
The urgency of the children’s needs has left little time for lengthy preparations and Yaya has immediately begun interventions for all grades at the school. She is supervising teachers and counselors for the younger grades, and is focusing her attention on the teenagers, especially the grade 13’s who face final exams in May and are suffering all the symptoms of post traumatic stress, combined with disrupted lives which makes it almost impossible for them to study. Yaya is helping them understand these symptoms and provide them with coping mechanisms. She is advising the teachers on how to assist e.g. by providing shorter study periods, incorporating lots of short breaks, pairing students to assist each other. She is taking groups of older children back to the beach to help them overcome their fear of the sea.


On Yaya’s advise we are increasing the number of clinics at the Rose Children’s Centre to 3 times a week, and possibly more. She is training the hospital staff to recognize and identify children in distress to be refered to the clinic and will begin training clinic staff to assist in the program. She suggests we use the Children’s Memorial Garden as a healing place and that we encourage the children to help build the garden, by making a winding path of painted stones, painting their hand prints on the wall, planting..

Yaya – 14th March 05


Another journal from Kalmunai
> Half way through my trip and days continue to be enriched by new
> experiences, and new levels of learning and experiences with people I have
> met.
>
> Yesterday we went for another outing as a group. Great trip, beautiful
> country side, rice fields and a dam, or a lake or some large portions of
> water. we were supposed to get into a boat and see wild elephants
> (apparently at times you may see 150 of them) but no chance. A policeman
was
> nice enough to allow us to come into the gates and climb to another big
rock
> - ha. But no boats allowed. Sally could not resist and got herself into
the
> water. Later on, as we are passing by another portion of water. with many
> water buffalos, here she goes again. She is attracted to water as I never
> imagine. but today she has a horrible sore throat and we diagnosed a wbs -
> water buffalo syndrome.
>
> By the afternoon we were all cooking in the van despite all he windows
wide
> open, and voila, a surprising vendor with many watermelons - we bought 5
of
> them and continue our journey, until we found a place indicating a
> restaurant and bar - ah. Another surprise, as everything here.a place that
> could be a nice place anywhere, brazil, even in Canada. So, we enter -
open
> spaces with lovely tables and chairs, and there we go, giggling like kids,
> cutting our water melons and having fun, after many hellos we figured that
> perhaps it was an abandoned place, but a man came after few minutes and
we
> bought beer and orange crush and he was very happy and did not mind we
were
> making a meson the table with our water melons.
>
> So, we left well fed, and went to another beautiful site - a budhist
temple.
> Wonderful space and I even meditated for a while.
>
> Today I am talking to a group of 45 students in a school nearby one of the
> camps and one student simply fainted in front of me - for 15 minutes I did
> everything I could, knew, than I called pargat and here he comes, takes
her
> in a "too too" to the hospital and she was admitted. Her story, as many
> others is brute, but by now I am getting accustomed, not less alarmed by
the
> potential distress in their minds.
>
> And here is another day. tomorrow I will take a large group of kids with
the
> pe teacher of one school to the beach. Everybody wants to come, and see,
and
> perhaps even the media. Ha I just imagine what will happen. Tell you
later…
>


Josephine 16th March 05

…There is still a great need for pediatric support in Kalmunai, not only at the Base Hospital but also in the Muslim hospital and at the surronding smaller centers. The pediatric clinic has over 100 patients every day. We have reduced this clinic to 3 times a week on a trial basis and are using the time to support the Muslim hospital and conduct outreach clinics. These have been well attended and we find we are reaching children who have not been to the Base Hospital. We are treated such things as infected wounds, asthma, and really a whole range of diseases.

I think we need to maintain at least one pediatrician and 1 RN at Kalmunai on a continuing basis for the next 6 months..

..Our main area of concern now is the psyco-social needs of the children. We sent an expert Dr Yaya de Andrade to Kalmunai. She has done an assessment of the needs of the children and has started a pilot project working in one school with 12 volunteer local counselers. Seh has developed programs for each of the grades and is working with the staff, assisting them to meet the needs of the children and their own needs.
One of the areas of great need is the teenagers. They have been somewhat neglected as a group and are struggling to study for exams. Many are displaying the symptoms of Post traumatic stress: ie inability to concentrate, inability to make decisions, depression, rage, suicidal thoughts etc. They return hoome at night to unlit tents and have no where to study.

We have also started the Rose Children's Centre as a referral centre for children who need extra support. The clinic meets 3 days a week and is aimed at children up to about 10 years of age. We need play therapists to assist us at this clinic…..


Yaya – 17th March 05


>
>…. A few things (new) happened today. Good ones in my view as I am learning.
at
> all times.
>
> First we had our first psychosocial morning. A teacher brought around 8
> students and we worked with them for a couple of hours. It was good, the
> counselors came late (communication is not 100%) but were efficient and
> theanne and sally (nurses) were of great help. It was good for a first
> opening, knowing that not many people knew about it. But perhaps this is
not
> the best way to help specific kids because it is school time, and going to
> school remains the best option (in my view). Although the nice thing about
> the morning at the clinic was that one girl - who was admitted after a
> school session (follow up by pargat in the ward) and is now under dr.
> kumudini - spent time with the group, and enjoyed very much because a
> couple of the girls who came were from her class. So, great support for
her
> (she will remain in the ward for a couple more days).
>
> I had the opportunity to attend a meeting of NGOs and locals planning
> psychosocial activities. I reported in our work and was surprised how many
> people were interested. But realistically UNICEF is planning more training
> to volunteers (I am not sure how our counselors, who are payed will feel
to
> be part of that ) as well as 5 community centers to address not only
> children but also women, men (who need self help group due to alcohol,
etc.)
> widows, orphans, and elders. They want to have a place in which all people
> can use and is focused on various activities, including in housing
training.
>
> Dr. kulmudini introduced me to a young man who is a teacher-counselor and
he
> agreed to replace me in the supervision and on going training of the 12
> counselors. They need more training. Their experience and background is
> different and as you know, 3 of them have some formal training while the
> others don't. this may pose a problem in the future, but they all can
help.
>
> My sense is that school can make good use of the supportive counselors,
and
> they need to learn how to refer when children may need something more than
> support. So, we have to count on the skills of someone who is capable of
> assessing risk, needs and provide appropriate assistance to the children.


Yaya 19th March 05


> Ah. babushka, a small kitten that theane decided to keep at the house was
> badly beaten by a big, mean cat. Someone run to the hospital, brings drugs
> and there she is, being treated by a pediatrician and 3 nurses. I watch
all
> this in awe. One week later babushka is running around, with an ugly cut
on
> her belly but alive and well, eating all the cockroaches and flies that
she
> can catch.
>
> This week I started working in 2 different schools. One of them was small,
> around 100 children, from those 49 died in the tsunami and the school was
> totally destroyed. The teachers run classes now at the house of the
> principal. The conditions are very poor, and the kids all sit nicely as we
> talk to them, the counselors interacting with them, playing while I talk
to
> the teacher. Nice people, making the best opportunity from a situation no
> one could control.
>
> Today was my last day at Fatima school, where I worked the last 2 weeks. I
> have met all the 100+ teachers and many more hundreds students. They were
> lovely, and as I meet them around they tell me that they are now
breathing.
> and laugh. And this afternoon as we finished the last group of teachers,
> here comes the principal and all and gave me a gift. They made a speech
that
> took me almost to tears. They said that they were happy because I came
with
> love and stay with them, and told breathing is good. We all laugh. And
they
> expect that I come back in 3, 4 months and they will tell about the
practice
> of meditation and all exercises we talked about. Their NORMAL reactions
are
> now all labeled, and there is no denial.
>
> On the other front,. I went for ice dream with theane
and
> sally. Wonderful mango ice cream, and we drove around the camps, stop for
a
> while to talk to a woman who wanted to tell her story, and show us the
> destruction of her home.
>
> I wonder how come we don't have lots of young men coming from our
countries
> and working on building, rebuilding, cleaning up - I can see an army of
very
> young men and women (perhaps grade 12 with credits) who would work daily
and
> in one week Kalmunai would be a very clean and nice city. What a dream.
> There was an article in the paper today about the money given by the west
> disappearing who knows where. and phony people claiming they are refugees
> who lost their homes. What a shame.
>
<

Yaya 25 March 2005

Journals from Kalmunai
>
> we had a wonderful lunch at the sea breeze restaurant, in the mids of all
> the destruction and as always, we heard stories of people on the roof of
the
> restaurant - which seems to me very solid... delicioius prawns, rice, and
> especially freshly done guava and mango juice
>
> It is Saturday, and in one week I will no longer be in Kalmunai. Last
night
> pargat and I were invited to dinner at a.'s mother in akkarapatu, one hour
> from here. The trip as always, was interesting going through muslin areas
> and tamil areas. The muslin communities are well organized, lots of bakery
> (with sweet buns like Portuguese) and good roads, while the tamil areas
are
> poorer, no lights on the road and commerce is less alive. These distinctive communities seem to be living well
side
> by side, despite their difference in wealth.
>
> The dinner was a typical lanka. someone come with a jar and bowl and you
> wash your hands, the water is literally thrown out (of the house) and next
> person washes, etc. coke was served to drink and the food was a series of
> bowls - pargat kept telling me to use the hands to get the food from the
> bowls - oh well, some of them. For ex. The rice, some kind of noodles,
> boiled eggs, fried little fishes like sardines, a delicious tapioca with
> curry, and chickpeas. Imagine. And there was some vegetables with chillis
> that I only looked at. Well, I am almost an expert eating with hands as I
am
> with chopsticks, and serving also (very clean hands - be sure). At the
end,
> another round of washing hands and for desert I was given a delicious
guava.
> Ah. I enjoyed so much that mother gave me another one that I share with
the
> nurses in the morning. Really good. Like brazilian, red and juice.
>
> Today I am going at the orphanage and distributed some more crayon. Cheryl
> was right. The crayola boxes have been a great success with the children.
I
> made bundles with elastic bands and we give away to the children. They
have
> so little of nothing. and they smile immediately at the colorful sticks
they
> get all the time.
>
> Yesterday all counselors and all in the house came to the ocean. No kids
and
> I realized that perhaps their parents still not permitting, protective and
> afraid perhaps. The counselors were reluctant at first, but in the end all
> came. One has no idea about what has meant to each and all to be there and
> be engulfed by the mass of water. I was somewhat concerned but in the end
> was a great experience. the counselor who lost many members of family
asked
> me to come together and we did, and she cried, and we laughed and it was
all
> beautiful. Later I told a story I knew about difficult to have closure
when
> someone loose someone and do not have the opportunity to see the dead body
> of that person, to look at it and come to terms with end of life. Very
> budhist I thought. Too philosophical perhaps. But they look at me and knod
> their head in this funny sri lanka way that you don't know if they are
> saying yes or no.
>
> Well, these contacts are very present and I keep passing on my love to
them,
> my sense of optimism and lots of hope. They all need, but in fact I
realized
> that being in Kalmunai and meeting these beautiful, simple and poor people
> made me a better person, so I only wish that the opportunity of the
tsunami
> in Kalmunai will transform this place in a better community to all,
> especially the children.
>

From Carol R.N.


March 25, 2005
>
> Hi all,
> We are now in the home stretch, I am now trying to decide what should be
packed at the bottom of the suitcase and what needs to be near the top.
This will probably be the last email from Sri Lanka but I will do a wrap up
when I get home.
> Palm Sunday was very interesting, the service was at 7 am in the cool of
the morning, which is a treat. The service was in Tamil, of course, but we
managed to get the gist of it all. There was at least 450 people there and
the procession was long and colourful. We very much enjoyed the service.
> After the service, the Project Co-ordinator took us to the site of the
proposed Childrens Community Centre. It is next to a lake where the water
purification takes place. It is operated by Operation Blessing along with
World Vision and makes thousands of gallons a day which is distributed by
bowsers, big water tank trucks to the various storage tanks around the
area.
> The site will be next to a resettlement project to be built by World
Vision for 300 homes. The breeze off the lakes is very nice and the
proximity to clean water is a real positive.
> On the way back we stopped at what looked to be a newly built refugee
camp. The huts are open and made of tubular steel with thatched roofs. The
people there told us they do not have a water storage tank and that no
medical NGOs had ever visited. We went back the next day, the Co-ordinator
had got a tank and it was set up, he was also organizing a bowser to fill it
on a regular basis. We did a clinic, saw at least 60 people, sent 1
straight to the hospital with congestive heart failure, saw a 12 year old
with tonsils that had just about obstructed her throat, another young teen
with a very irregular heart beat who had never seen a doctor, a young man
who a year ago stepped on a land mine and needs a revision of his stump, a
year old boy with a ring on his finger that had to be cut off as his finger
had grown around it etc., etc., it was basic medicine! Of course we also
saw the 60 year old who has had knee pain for 8 years but I really felt that
she might be followed long term
> elsewhere!
> We also started to teach first aid to our second group of nurses as well
as to a group of teachers. The teaching conditions are less than optimal,
the room at the hospital was crowded, hot and had no tables but the learners
were very eager to learn. Their English reading skills are quite good, all
their Nursing education was in English. The real problem is not in what
they do not know, it is in giving them the confidence to use it. I found
out from them that their base salary is 15,000 rupees, about $150 a month!
The cost of living here is certainly less than ours but not that much!
> The teachers provided a very nice room in a local school. The principal
was very welcoming and she showed us around and pointed out some of the
deficiencies. One of the teachers is interested in being an Instructor for
First Aid, St. Johns is quite active here. We are leaving our teaching
materials here for him so he has some resources.
> We went to the pediatric ward and gave away all our stuffed toys. We got
pictures of each one including two who were not too happy about being given
the toy but the mothers were grateful!
> The local flora and fauna are very different. The mosquitoes are very
tiny, not what we are used to, the geckos look after most of them but they
still bite! We have some squirrels that are striped like chipmunks that run
around the tops of the cement walls and a few iguanas that wander in and
out. One night I awoke with a cockroach on my chest, that was about the
worst that has happened and we count ourselves lucky!
>
> Carol

www.RoseCharities.org The Name....

The RoseCharities emblem is a stylized rose with five petals. Rosa rugosa, one of the oldest species
of rose had five petals and pentagonal symmetry

The Rose has ties to the fivepointed guiding star of Venus as well as the
Compass Rose. Since ancient times it has thus represented both the qualities of femininity
caring, nuturing, creative motherhood and that of guidance of direction. It was the early
Christian symbol of the Virgin Mary.

The rose's close link to the concept of 'true direction' and navigation is indicated in the 'compass rose'
as well as the 'rose lines' , the longitudinal lines on maps.

For the reasons above , the Rose was a symbol
that spoke of the Grail — womanhood, and
guidance—the feminine chalice and guiding star that led to secret
truth."

Despite these symbolic images, which link very closely into the ideals of RoseCharities, they were not the reason for the direct origin of the name of RoseCharities. This came from in fact from two springs with one or two additional factors...

The first was that it followed on from the floral theme of the organization from which it 'budded' (initially as a subunit.. IRIS (International Resources for the Improvment of Sight), the ophthalmic organization founded by Mme Michele Claudel, Dr William Grut, and Mr John Stewart in 1995 to provide free eye surgery for sight restoration for the poor of Cambodia and secondly because it could be fitted into Will Gruts (rather contrived) acronysm 'Rehabilitation Oriented Surgical Enablement .. ROSE. Despite the wording convolutions though they did represent the main goal of Rose in the only area in which they were operating at the time, namely the provision of (and training for) low cost, simple, sustainable, safe surgical procedures which were oriented solely at the improvement of quality of life by rehabilitation.