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Memo to Tsunami Relief Officials: Get Organized

Disaster Specialist Makes Lists in Effort To Streamline Aid

By David Brown
Washington Post Staff Writer
Tuesday, February 1, 2005; Page A13

CALANG, Indonesia -- Joel Selanikio, an international relief specialist, set up a chart on a makeshift whiteboard one day recently in an attempt to bring a little more organization to the humanitarian effort of which he is a part.

He listed dates on the left and the names of places and tasks along the top. On the lower right was a list of upcoming departures of people and supplies to be ordered from Banda Aceh, the provincial capital. Next to it was a list of important questions yet to be answered.

Joel Selanikio talks to a patient in Banda Aceh, Indonesia. A disaster relief expert, he says such efforts need better organization. (Photos David Brown -- The Washington Post)

Organizing has become an obsession for Selanikio.

The aid provided to Indonesian survivors of the Dec. 26 tsunami has been marked by extreme generosity and dogged work, but also a fair amount of confusion and duplication. The barrel-chested Selanikio, a physician with the International Rescue Committee (IRC) who has a decade of relief work and disaster-preparedness experience behind him, said the operation could use more centralized decision-making, planning and technology.

"The field advances very slowly," Selanikio said, a note of frustration in his voice.

He said he welcomed recent moves by the Indonesian military to take a bigger role in directing humanitarian aid groups in this town, which once had 8,000 residents and now has 2,500 tsunami survivors living in hand-built shacks. But his feelings don't have to do with his admiration of the military -- he is, in fact, a Quaker. It is because the military might make the work more efficient.

"I'm not an idiot. I know what the Indonesian military has done in the past," he said, alluding to abuses in East Timor, the former Portuguese colony that was occupied by Indonesia and became independent only after battling the Indonesian military's proxy militias. But he said every private group he's spoken to has said the military had "done a very serviceable job here."

If the host nation does not assert itself, humanitarian relief will remain largely unstructured. While U.N. agencies and the World Health Organization (WHO) help organize and steer relief efforts, they don't have the authority to order a nongovernmental organization either to do something or to cease doing something.

Nevertheless, order and standardization are coming to his business, Selanikio said. He gave as an example the existence of the "basic medical kit."

This is a box that contains the necessary supplies for providing primary care to 1,000 people for three months. WHO certifies the contents. Relief groups know what they have, or are getting, in such kits.

Selanikio thinks there should also be a "basic administrative kit," perhaps not WHO-approved but at least standard to an organization such as the IRC. It would contain a purchasing ledger and receipt book -- relief work involves lots of logistics and labor management -- and a folding table and chairs. Modular shelves would be a possibility, so medical supplies could be quickly organized, he said. And a whiteboard.

Anything that makes relief work more efficient has the power to relieve misery more quickly and even to save lives, he said.

After graduating from Haverford College outside Philadelphia in 1986, Selanikio worked as a computer systems analyst at Chase Manhattan Bank, helping that organization incorporate networked personal computers into its operations.

He returned to school to take premedical courses, graduated from Brown University's medical school and did a three-year pediatrics residency in Atlanta. He then joined the U.S. Public Health Service, a uniformed service with a command structure similar to the Navy's.

During his time there, he helped run disaster relief activities for the Centers for Disease Control and Prevention after several Caribbean hurricanes, worked with refugees on the Thailand-Burma border and took part in CDC-affiliated public health projects in several African countries.

After letters containing anthrax spores were mailed to Capitol Hill in late 2001, he served for three months as head of the emergency command center set up by Tommy G. Thompson, then secretary of health and human services, at HHS headquarters in Washington.

In Indonesia, Selanikio first headed one of the health assessment teams fielded by the IRC and a consortium of relief agencies. He visited villages around Calang to determine how many residents remained, what they needed and what illnesses they suffered from. But he spent more time treating seriously sick and injured people than he did gathering epidemiological data.

After gaining firsthand experience in the field, Selanikio told IRC staffers at a meeting that perhaps the basic medical kit should be modified to include instruments for minor surgery, antibiotics for skin infections and expensive but life-saving tetanus immune globulin when the destination is a trauma zone.

Last year, after nine years with the Public Health Service, Selanikio quit and started a two-person company called DataDyne. It is headquartered in Washington, where he lives. With it, he hopes to promote efficiency and standardization in epidemiological investigations carried out in remote and often underdeveloped places such as the tsunami zone.

Today, most epidemiologists from the West and virtually all from the developing world collect data during humanitarian emergencies and natural disasters using pen and paper. The full results end up in someone's file cabinet, unavailable to others.

Selanikio wants to change that by producing user-friendly software for hand-held computers. The package would include survey forms -- with questions agreed to by key organizations -- as well as a few basic reference texts and calculation programs. The whole thing would be very cheap, and possibly free for health ministries in developing countries, he said.

"People raised all kinds of objections to using hand-helds in the field -- that it's too complicated for people in developing countries to do," he said. "We tried it, and none of those problems happened."

Selanikio's DataDyne partner Rose Donna, a computer scientist, recently wrote a program provisionally called EpiSurveyor that got its first small test here and will have a bigger one soon.

Selanikio said he hoped that people undertaking standardized, computer-based data collection would agree to store a short description of their findings on a searchable public Web site after a specified time -- perhaps a year -- with the understanding that the complete, raw data would be made available. That would allow others in Selanikio's business to learn how disaster populations differ from one another, what the key variables affecting survival and welfare are under different circumstances and, ultimately, how relief organizations can best help.

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