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In Aceh, Aid Groups Seek a Niche

Relief Workers Struggle to Avoid Duplication When Many Needs Are Unknown

By David Brown
Washington Post Staff Writer
Tuesday, January 11, 2005; Page A10

CALANG, Indonesia, Jan. 10 -- In the effort to provide health services to this devastated town, the Germans got here first.

Their organization, Cap Anamur, reached Calang less than three hours before the delegation from the International Rescue Committee, an American relief group. Unfortunately, the Germans didn't bring any medicine with them. But the survivors of the Dec. 26 Indian Ocean earthquake and tsunami didn't appear to need it right away.

In the town of Calang, Indonesia, people carry scavenged materials past a concrete ramp painted with the question: (Photos David Brown -- The Washington Post)

"I think medicine is not the real problem here," said Werner Hofner, a Cap Anamur physician from Munich. "Same in Banda Aceh. People either died or they survived."

Hofner sat on a large downed tree trunk along a strip of denuded land sloping up from what remains of Calang's sea-level downtown. There are countless sliced-off trees like this one all along the coast. At the top of the rise, 50 yards behind him and above the tsunami's high-water mark, Hofner and his assistants had set up three tents -- blue, yellow, orange -- wide, squat and empty. They'd treated only seven patients before running out of supplies.

Richard Brennan, 45, an Australian physician who heads the International Rescue Committee's health unit, bumped into Hofner while exploring the Calang peninsula, where they'd been dropped off separately on Sunday morning by U.S. Navy helicopters. A Washington Post reporter traveled with Brennan.

Calang, about 60 miles south of Banda Aceh, the capital of Aceh province, was one of several places the IRC had selected as a site for its efforts to help survivors. This region of western Sumatra island was among the hardest hit by the tsunami, which killed at least 100,000 people in Indonesia and more than 150,000 overall in 11 countries along the Indian Ocean.

Brennan recognized Hofner from a World Health Organization planning meeting for health agencies last week in Banda Aceh. They had not spoken, but Brennan had thought Calang would need a primary care clinic, or the establishment and repair of water and sanitation systems.

Although the official who ran the WHO meeting made a list of relief groups, their interests and where they wanted to work, there was no sign-up list to prevent duplication.

So neither Hofner nor Brennan knew their groups had the same plan. Hofner said he thought such an approach was probably not practical. "In these situations, there is always a trade-off between coordination and speed," he said.

It is now unlikely that the American relief organization will set up a health clinic in Calang. Besides the Germans, the Indonesian Red Cross has a small clinic here, as does the Indonesian military.

But the presence of the German clinic did not appear to faze Brennan. An emergency physician and epidemiologist, he saw lots of other opportunities for the IRC to help the people of Calang. His profession is humanitarian relief. His approach -- and that of the IRC -- is to gather information first, then decide what to do.

Before his arrival, he tried to obtain statistics about the population of Calang. The estimates were unclear, ranging from 3,500 to 40,000. An Indonesian noncommissioned officer in the town told Brennan that Calang had fewer than 2,000 residents. The population data had given him a lead to examine alternative relief possibilities.

When the helicopter dropped him off in Calang at a makeshift landing spot -- a patch of cleared road -- Brennan asked the three Indonesian soldiers controlling the crowd to take him to a commanding officer.

He was led to five green tents set up across from a new, two-story house with a steeply pitched roof, one of only two largely intact buildings still standing. In one of the tents, Lt. Col. Heras had a chart listing the six subdivisions of Aceh Jaya district. The chart showed columns for the pre-tsunami population, the dead, the missing and the displaced. The entries were specific numbers, although they were described as estimates. According to the data for Calang, the original population was 14,000, with 5,611 dead, 619 missing and 3,700 displaced.

Based on about 45 minutes of observation, it appeared unlikely that thousands of residents could still be living in their original dwellings. The scene was an abstract canvas of devastation: white patches of concrete that were once the foundation slabs of buildings separated by black stretches of surviving road, all covered with the splatter of debris and personal possessions.

So Brennan asked why the chart listed so few displaced persons.

Heras said that he could not give a good answer, but that the person responsible for the numbers was available. Brennan said he would like to talk to him, but first had a few more questions.

What were the main diseases people had now? The usual ones.

Was there enough food? No. There was only rice, noodles and sweet biscuits.

Did Heras know of any deaths since the tsunami? No.

What would he like from an international humanitarian organization? Water purification.

The next stop was the tent of the civil administrator, Zulfian Ahmad, a stocky, deeply tanned man who was wearing a white polo shirt bearing the name and logo of a Jakarta hotel. He shook hands with his guests at the tent flap.

Ahmad's wife and three of his four children were killed in the tsunami. He sat on a plastic mat woven in an oriental-carpet design, supplemented by a large folded sheet of black plastic. He answered Brennan's questions, occasionally smoking, with a green butane lighter in one hand as he spoke. He had a spiral notebook with page after page of handwritten names of survivors.

Also present was Iman Jaya, a younger man who is head of the district health office. A man in the corner of the tent typed on a portable manual typewriter, and at one point delivered a carbon copy of the tabulation of the district's casualties as of Jan. 6. It was very different from the colonel's.

Seventy percent of the people of Calang were dead or missing, he said. There had been 10 doctors in Aceh Jaya district, all of whom died. Of the workers in the district's three public clinics, 20 survived. Clothing and some blankets were brought in, but survivors have acquired building materials, pots, water jugs and other necessities by scavenging in the debris.

Ahmad drew a simple map for Brennan of the vicinity, a peninsula that was hit by the tsunami from two sides. Brennan thanked the men, stepped outside and headed back toward the destroyed downtown area. Broken chunks of concrete, splintered boats and crushed cars testified to the power of the water.

A man was recruited to show Brennan the current sources of drinking water -- a few springs and stream-fed cisterns. He pointed out where his house had been, behind a coffee shop he ran next to the coastal road. The road was identifiable, but nothing else. On a concrete ramp nearby was written in yellow enamel paint, "Bawa Kam!" -- "Take Us!" Underneath, in Indonesian, were the words, "Whose sin is this in Aceh Jaya?"

Brennan came up with a plan as he walked around for the next four hours. He decided to conduct a survey of households, determining the needs of the population and some of its demographic features, including its size. He suspected there was plenty to do, especially in water and sanitation.

Late in the afternoon, Hofner, the German doctor, caught up with him and asked if he could spare any medical supplies. They were expecting a shipment of 20 tons of supplies on Wednesday. But patients were continuing to show up, including one who needed an intravenous infusion. Because IRC wouldn't need to deliver health care, Brennan had no problem accepting the request from the German organization.

Hofner and his Indonesian helpers followed Brennan down the hillside where Calang's residents were encamped. They crossed the wrecked downtown to the army tent where the IRC's box of medical supplies was temporarily stored. It contained enough drugs and related items to service a thousand people for three months. He gave Hofner half.

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