Tragedy overseas
Academy extends aid to children affected by tsunami
by Deborah Johnson
Correspondent
The giant waves that bulldozed Indian Ocean coastlines Dec. 26 exacted a terrible toll on children. Water ripped screaming babies from mothers, swallowed older kids as they ran for their lives and washed away moms, dads, homes, toys and even childhood itself. Youngsters who survived became vulnerable to disease, malnutrition, dehydration, mental problems and abuse.
Horrified, members of the Academy swung into action. Pediatric societies in India, Indonesia, Sri Lanka and Thailand received cash donations from the Academy to use in relief efforts. Copies of the AAP-endorsed handbook, Helping the Children: A Practical Handbook for Complex Humanitarian Emergencies, were rushed to workers in refugee centers. Member pediatricians with experience in relief work traveled to Asia, while others waited "on call" as part of the AAP CHILDisaster Network. The Academy also contacted the Union of African Pediatric Societies and Association Secretary General Joe Mbuthia, M.D., who said loss of life was minimal and little damage was reported in Somalia, Kenya and Tanzania.
"A third of the tsunami victims are children so we feel a kindred spirit with them," said AAP President Carol D. Berkowitz, M.D., FAAP. "And even if that weren't the case, we would think it was important to help, given the enormity of the event."
Assessing the needs of children is the first step pediatric communities must take in any disaster scenario, said AAP Executive Director Errol R. Alden, M.D., FAAP. He said the pediatric societies in tsunami-ravaged countries are doing that now. Once assessments are complete, the Academy has offered support to help the societies implement their plans.
Dr. Alden said it is important to realize children and adults cannot be treated the same way in a post-disaster setting. Children, because of their still-developing brains, are at risk for long-term psychological problems. Unsupervised toddlers are prone to dangerous activities such as playing in the sewer or drinking dirty water. Orphans often have food, clothing and blankets stolen from them. Breastfed infants get passed off to other caregivers by stressed and exhausted mothers.
"Even at present, there is a failure to recognize that children have special needs that are different than adults' in these types of situations," said Karen N. Olness, M.D., FAAP, immediate-past chair of the AAP Section on International Child Health.
Several years ago, the International Pediatric Association (IPA), guided by Dr. Olness, and in conjunction with the AAP Section on International Child Health and Johnson & Johnson Pediatric Institute LLC, developed an intense, five-day training course aimed at the specific needs of children during disaster. The course and its accompanying manual, Helping the Children, has been used to train pediatricians in India, Thailand, Pakistan, Ethiopia, Nicaragua, Panama and Syria.
Helping the Children addresses issues like encouraging lactating mothers to breastfeed despite their own fatigue, keeping families together to alleviate trauma, establishing schools so the kids have somewhere to go while parents rebuild, and establishing continuity in care-giving for orphans.
Tender, loving care is desperately needed by children swept up in a humanitarian crisis, said Dr. Olness. She plans to travel to Thailand to facilitate a special workshop on psychosocial issues and devise a plan to help young tsunami survivors avoid long-term emotional problems. She said these children are vulnerable to post-traumatic stress disorder and chronic depression.
"One of the best things you can do for children is to re-establish a routine," said Dr. Olness, adding that school and religious activities are important. "That gives them a sense that life will go on."
Dr. Olness and Jane G. Schaller, M.D., FAAP, executive director of the IPA, recently developed a list of recommendations on how the world pediatric community should respond to the tsunami emergency. They are as follows:
The IPA should continue to train pediatricians and other child-care professionals to give hands-on care.
The pediatric society in each country should facilitate long-term disaster planning with governmental bodies.
Pediatricians should publicly advocate for the long-term health needs of children in humanitarian emergencies.
The IPA should provide educational material such as Helping the Children to other professionals, such as teachers, community leaders and government officials.
Curricular materials should be updated.
Pediatricians should serve as expert advisors to ministers of health in each country.
Good relationships need to be established between pediatric societies, the United Nations and non-governmental organizations. A conference should be held to facilitate such relations.
The IPA should create a global registry of physicians who can be "on call" in an emergency.
A number of pediatricians called the Academy in the wake of the tsunami to inquire about traveling to Asia to help, said Dr. Alden. While such a desire is understandable, the Academy is discouraging that unless a pediatrician can speak the language or has had special disaster relief training. He noted most U.S. physicians are not used to working without proper equipment.
Dr. Olness agreed. "I've seen competent physicians who had a complete mental collapse when they got into the situation," she said. "I can think of three who had to go home immediately because they just couldn't deal with it."
Errol C. Baptist, M.D., FAAP, an Illinois physician born in Sri Lanka, plans to return to his native country in April to assist as part of a team. He believes his assistance will be more valuable after a few months have elapsed and the excitement has died down. Then, he said, he can help "pick up the slack." Dr. Baptist also noted that by April, his practice's own flu season will be over so he can spend more time overseas.
Speaking by telephone from India Jan. 10, Dr. Schaller said she is proud of the work being done by the region's own pediatricians. No additional manpower is needed from the United States, unless a physician is part of an organized relief effort. "Useful assistance must come at the request of the people who live here," Dr. Schaller said.
"It makes a difference to people here (in India) that their colleagues know what's going on and care about it." Dr. Schaller said.
Interested in volunteering?
The AAP Section on International Child Health maintains a standby list of professionals who are screened by a subcommittee and prepared to assist in disaster relief.
Participants in the CHILDisaster Network have special training in child health disciplines and disaster relief. The list allows relief agencies to search on-line for people with specific skills and language abilities. After locating someone, these agencies call the physician directly.
For more information or to apply, visit www.aap.org/disaster. A username and password are needed to perform a search. Those without a username/password should contact the Academy at (847) 434-7658.
How to contribute
Pediatricians can support pediatric relief efforts by contributing to the AAP Friends of Children Fund. Mail checks payable to the AAP Friends of Children Fund, American Academy of Pediatrics, Development Lockbox, 38367 Eagle Way, Chicago, IL 60678-1383. Write "tsunami relief effort" on the memo line.
As of Jan. 14, the fund had received over $23,000 in donations.
