Sirens and Lights

We pulled up into a dusty lot today, at the base of the sand-coated foothills near Ica, scattering dogs and attracting children. Fold out tables were quickly unloaded and loaded with boxes and papers: medications, vitamins, facemasks, color-coded triage sheets. Bags stored in the goal box at one end of the field gave away the lot’s typical use, before it was transformed in an impromptu medical clinic in this shantytown, named for a former president’s wife.

Unlike yesterday in the IDP camps, today could almost have been a clinic on any day in this town, where tenuously constructed homes are the norm; we could have been any one of a number of medical organizations that do these sporadic clinic days in similar dusty lots in underserved areas all over the world. The particularly destroyed homes bordering the lot gave a hint to the conditions specific to our motivations, as did the occasional complaints of children and adults who are unable to sleep, are having nightmares or are having crying spells typical of acute stress reactions post-traumas such as natural disasters (20% is the WHO estimate). Despite all of this, the care we provided could have been given on any day- upper respiratory infections, eye exams with glasses distribution, parasite infections, severe dry skin from the cold and dry air, dental extractions…

I guess what I’m trying to say is that it seems impossible to separate the victims of this earthquake from the regular victims of poverty, at least in the time period following the immediate post-disaster deaths from trauma. It’s the poor with their adobe homes that have been left homeless, and to live in camps without nearly enough toilets or water, where infections will almost inevitably spread. It’s the poor who never really had access to medical, opthamological or dental care that most benefit from the post-disaster care, in large part because they never had access to care before. While this is “relief” medical care for others as they begin to piece together their lives, for these people, these humanitarian efforts likely may be the closest thing to routine primary care such as eye care and de-worming that will come this close to this settlement.

Manning the overwhelmed triage desk and attempting to explain our limitations in service (including that we wouldn’t be there ever again, most likely), I really felt the lack of sustainability of our work today. This isn’t relief work, where sustainability isn’t the objective; it’s primary care– which, of course, I knew it would be given the realities of the distribution of health care in most of this world. I’m happy we were there because I do believe that we need to do what we can and people have suffered more because of this earthquake, but this isn’t how primary care is supposed to be done to help people, without continuity or sustainability. It’s frustrating to leave things like this. Relief isn’t supposed to be primary care.

President Garcia here has acknowledged that the inferior communications networks in this region of Peru contributed significantly to the delay in rescue efforts here, and commented specifically that this should be motivation for the entire country to commit more strongly to improving these systems and the other weakness exposed, as it often happens, by natural disasters such as this earthquake. I hope that these weaknesses to be addressed include those in the system of health care, and that these relief efforts can lead to something more consistent. Wouldn’t that be making something good from such a huge disaster?

This entry was posted on Saturday, August 25th, 2007 at 10:11 pm and is filed under Emergency Medicine, Peru. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.