Cyclone Ditwah Killed Hundreds and Blocked Sri Lankans from Aid. A Medical Team Reached Them.

When Cyclone Ditwah battered Sri Lanka late last month, killing more than 600, landslides and infrastructure damage cut whole communities off from aid and medical care in the country's north. In the following weeks, Shannon Fernando-Rubera's team focused on reaching them.

Speaking to Direct Relief on her way to a mobile clinic in Sri Lanka's rural north, Fernando-Rubera, a nurse practitioner and founder of the nonprofit organization Alabaster International, described a path of medical aid that her team cut across Chilaw, Puttalam, Mullaitivu, and other hard-hit communities over an eight-day journey.

"We often go where others won't or can't go…to rural or inaccessible areas," Fernando-Rubera explained. "That's our ethos: to go where others may not be working."

Fernando-Rubera was born in Sri Lanka but has been living in Kenya for years, working in conflict and disaster settings across sub-Saharan Africa.

Traveling with her fellow providers by bus to these northern communities, most of them cut off from humanitarian intervention by the sheer scale of the physical damage, Fernando-Rubera described patients who had lost everything living in flooded, damaged housing. Many of them were older adults who had struggled to survive Sri Lanka's decades-long civil war, which ended in 2009.

Setting up a medical camp in one heavily battered village, she recalled, an older man was the first to arrive.

"He was desperate to be seen," she explained.

The nearby clinic where this patient usually received treatment for heart disease was flooded out, its doctors displaced themselves or scattered to supervise medical clinics elsewhere.

"He's had multiple heart attacks and is terrified he will have another," Fernando-Rubera explained.
During his examination, the patient began to sob. He explained that he'd stood neck deep in the floodwaters with no one to help him. "I live alone and thought I was going to die," he told Alabaster International's providers. My house is still flooded and the rains don't stop. The mattress I sleep on is still wet."

For Alabaster International, invited by Sri Lanka's Ministry of Health to participate in a widespread response to Cyclone Ditwah, this mission was their first time working on home turf.

"Our own families have been affected, as well as many families who didn't have the same privilege or resources," Fernando-Rubera said.

She described caring for children in orphanages whose few possessions had been swept away. People who described watching loved ones and pets lost to the floodwaters. Older adults who'd struggled for decades to survive a civil war, and now weren't mobile enough to reach a distribution site or mobile clinic.

For those patients, she said, "we went boots on the ground with our backpacks from home to home."

Those backpacks were supplied by Direct Relief, which outfitted Alabaster International's team of providers, working side-by-side with local physicians, with five field medic packs, 10,000 water purification tablets, and 3,500 sachets of oral rehydration solution, to prevent water-borne illnesses and mitigate their effects where they'd already occurred.

"We didn't have time to get donations or buy supplies," Fernando-Rubera said. Being able to work quickly with Direct Relief's emergency response team to outfit providers made it possible to respond more quickly and thoroughly.

"I can't really explain in words how important and critical it's been" to have the packs, she told the organization. Many patients urgently needed treatment for wound care and other physical trauma; for severe skin conditions caused from being washed away or wading through floodwaters; or for chronic diseases like diabetes, hypertension, and kidney disease.

The backpacks "allow us to really give comprehensive care; we can respond to all the needs a patient is presenting with."

Moreover, field medic packs - a recognizable medical aid item - have provided credibility where it was badly needed. Fernando-Rubera said many Sri Lankans are skeptical of outside help, as humanitarian workers sometimes promise aid or medical care that then isn't given.

"Having that credibility has given us access where we wouldn't have had access," she explained. When the team arrives, wearing field medic packs, "people in the community see that we are medical providers."

In addition, Fernando-Rubera said all the tablets and sachets were quickly claimed and urgently needed, both by communities and regional health providers.

Her team reached about 360 patients through medical camps and home visits. Older patients were evaluated for malnutrition, and people who needed more extensive care were referred to hospitals. Providers taught the communities where they worked about how to prevent water-borne illness, keep wounds sanitary as they healed, and manage chronic diseases amid the difficult conditions.

When the team walked through the streets of a village or town, she said, they were frequently flagged down by people with a sick or immobile family member at home. One woman approached the team at a medical camp, asking them to visit her mother, who was confined to bed and had severe bedsores. Both mother and daughter had been washed away from their home in the floods - the older woman with very limited mobility. "It's pretty much a miracle she survived," Fernando-Rubera said. "Natural disasters really impact the most vulnerable, and oftentimes that is the elderly or children."

There is still tremendous need in the communities where Alabaster International visited, Fernando-Rubera said. Many families have lost their livelihoods and all their crops, and urgently need food and nutrition support. And mental healthcare will be an ongoing need: "Having lived through the war, having lived through the economic collapse a few years ago, and now having lived through a tsunami-like experience," symptoms of post-traumatic stress and other mental health conditions are widespread.

But responding to Cyclone Ditwah has given Alabaster International's team a sense of how they can do the most good in Sri Lanka going forward.

"There's not really a paradigm here yet for mobile medicine," such as the medical camps and home visits the team routinely provides in the countries where they work, Fernando-Rubera said. "It's an opportunity for us…that's really how we do most of our healthcare."