Three New Zealand nurses become a small part of healing in Banda Aceh: running children's clinics, teaching basic hygiene and organising training programmes for teachers were just some of the activities three volunteer New Zealand nurses undertook in Banda Aceh, Indonesia, following the tsunami.

Following the devastating Indian Ocean tsunami on Boxing Day 2004, three New Zealand nurses were quick to accept the challenge that voluntary relief work offers. Two nurses from Dunedin Hospital--Angel Mathis from the emergency department and Christie Peacock from a medical ward--and I left for Banda Aceh, Indonesia, in March for a month. This is our story of care and compassion in the midst of an area of immense devastation and suffering.

Aceh is the strictly Muslim province of Indonesia situated in the northern tip of Sumatra, five degrees north of the equator. Prior to the tsunami that kilted over 235,000 people and left nearly half a million people homeless, the area was closed to foreigners because of the armed independence movement, GAM. This in turn had caused the Indonesian Government to declare martial taw in Aceh, accompanied by severe repression from the Indonesian military, with many stories of "disappearances" and human rights abuses.

We were part of a larger team from a group called Servants To Asia's Urban Poor, a nondenominational Christian organisation. An important aspect of Servants' philosophy is to live and work among the poor. The team included experienced development worker Rob Bellingham, Dunedin doctor and Otago University lecturer Steve Tripp and New Zealand community and psychiatric nurse who has been living in Cambodia for 10 years, Kristin Jack. The three nurses worked primarily on their own, while Tripp was either visiting isolated communities or at meetings with other aid agencies or government departments, trying to se cure our official registration. This was a vital part of our continued presence in Aceh, as without government approval we could not have stayed in the area.

On arriving, we tried to find a niche to work in among all the other aid organisations, helping out in various clinics around the area. Initially this was a struggle as we were expected not only to be nurses, but doctors and pharmacists as welt. The Achenese would line up outside the clinic where we were stationed, and come in as families for advice and medication. Some of our first clients included a man with a severe cellulitis in his foot, possibly with a metatarsal fracture as well; a three-year-old with acute lymphocytic leukaemia who had a severe mastoiditis; and a 12-year-old with thalassaemia major, needing blood transfusions and splenectomy. Actually, we saw relatively few really severe injuries resulting directly from the earthquake or tsunami. The initial onslaught of collapsing buildings and huge waves had been so severe that few of the injured survived, and those that did mostly died in the first 48 hours before urgent medical attention could get to them.

Medicines had been donated from all over the world, and they lined the walls of a room dedicated as the dispensary (the only truly cool place in Banda Aceh, as the air conditioner and fans were a necessity for maintaining the medications' efficacy). It was a challenge to find the medicine we thought best for the client. All the pharmaceuticals were in various languages--German, French, Indonesian, Indian, Arabic. Sometimes a helpful soul had found out about the medication and had la belled it, stating its purpose, e.g. "arthritis medication, has stomach protection, good for elderly".

We were more than a little nervous about dispensing, considering the legal implications we face here in New Zealand. One American nurse reminded us that our administration of medication might be the only hope for a patient who otherwise would continue to suffer physical afflictions, as well as the emotional and mental scars already formed. We would not have managed at all without wonderful Indonesian translators who quickly became our friends. One week after our arrival, the team spread its wings and went further afield to work with some communities along the coastline. We teamed up with an Indonesian Baptist Organisation from Jakarta which was running a children's programme. We took medicines out to these communities and focused on running children's clinics at the end of the school day, functioning in large tents donated by UNICEF. Parents and teachers also came to ask medical advice and we found there was a need for diabetes care, blood pressure monitoring and antenatal care. Every child we saw received multi-vitamins, and each pregnant or breast-feeding mother was given prenatal vitamins. The three nurses saw approximately 40 children in about an hour at each clinic. Conditions included failure to thrive, skin infections (scabies, impetigo, cellulitis, fungal infections), gastroenteritis, tuberculosis, ear and eye infections, dental caries, respiratory tract infections, chicken pox, arthritis and parasitic infections, eg worms. One of the communities we worked closely with, Kreung Raya, lost 1200 people in the tsunami, and every child who attended the school had lost at least one parent. A quarter had lost both parents. All the houses in this community had been destroyed, but in the two months following the tsunami, they had rebuilt some huts out of salvaged timber up the hill, away from the threatening sea in an old limestone quarry site.

After we had started to develop relationships with children, parents and teachers, the opportunity arose to start teaching the children basic health education such as hygiene, handwashing and sanitation. We organised hygiene kits to go to each family. The kits contained such necessities as soap, shampoo, toothbrushes and toothpaste, towels and mosquito nets. The opportunity also arose to do a teacher training programme to equip the teachers (most of them volunteers from elsewhere in Indonesia) to teach the children and involve them in health programmes within the school The aim was to assist teachers to identify hearth problems so they could then involve the community with problem solving and implementing positive health changes.

One example was sanitation. The teachers had identified that many children were developing diarrhoea. We trained the teachers about how diarrhoeal disease is spread, and, with assistance, they were able to solve the problem. The whore community then worked together to implement strategies for decreasing the incidence of gastroenteritis. They recognised the importance of handwashing and using latrines, but as they had no facilities for either, they started to work on addressing these needs. Also identified was a need for better rubbish disposal so that flies were not attracted, thereby reducing the spread of infection. As nurses we were very conscious of the importance of empowering the community at a time when much of their control had been lost due to large aid organisations coming in and taking over. This was yet another toss the community was facing, following the toss already experienced by the tsunami tragedy.

As well as preparing teaching sessions for the children, running the teacher training sessions, the school clinics, and keeping our medical supplies topped up, we also submitted a proposal for a long-term, school-based health education programme to the district health department. None of us had ever done anything like this before and we were a little nervous. If it wasn't accepted, we may have been forced to leave Aceh. Authorities were starting to tighten the taws about which agencies would be allowed to stay long-term. Eventually the good news arrived. Not only had the authorities at district and provincial level accepted our proposal, they also wanted us to implement it in all schools in Aceh! As there were only the three of us remaining at that stage, we realised it was not a realistic option. Our hope and prayer was that more workers would come.

Working in a Muslim culture brought its own challenges. Women are forbidden by taw to go outside without covering their heads. A head scarf was a new item of clothing for us, which we sometimes struggled with due to the heat. Each time we wore our head scarves we were rewarded with a flurry of complements from men and women alike, telling us how beautiful we were. We also woke and went to bed with the sound of the muezzin (call to prayer). It was important for us to learn to structure our day to allow for the prayer times attended by teachers and our translators.

The job did not come without its dangers. Firstly, there were the ongoing aftershocks which threatened the already weakened buildings. We had also been informed that two king cobra snakes had been removed from our accommodation compound before we arrived, luckily we didn't see any others. The unstable political situation, from both the military and GAM forces, was also potentiality dangerous.

Despite the potential dangers, the rewards were many. We made some incredible friendships with people who had suffered so much. We felt an enormous privilege to be a small part of healing in these people's lives. They welcomed us into their homes and lives, and encouraged us with their stories of humanity and survival We felt we were as blessed by the Achenese people as they said they were by us.

I have many memories of my time in Aceh, many of them sad. But the ones that will stay the longest are the sounds of Aceh--sounds of saws and hammers as people rebuild, and the sound of children's laughter as they [earn to play and be children again. These are the sounds of resilience.

'NO WORDS'

What do I say to a man who cries and tells me he has lost everything? When he arrived home after the tsunami, he found a ship the size of a football field sitting, not only in the middle of his suburb, but on his home and the homes of his neighbours. He has never found his family. What can I say to comfort him?

What do I say to an eight-year-old child who has lost her mother and father, three siblings and her home and belongings in a beachside village near Banda Aceh? A teacher brings her to me for medicine for the skin infections she has had since the tsunami. She doesn't smile now. What can I do to ease her grief?

What can I say to leaders in the community where I am working? All the children in the school I am working in have at least one parent dead. I know how I feel when one person I know dies at one time. I can't comprehend their experience. How do I tell them I am sorry for their loss?

What do I say to the woman who has come to see me with her daughter, who cries with tears of grief and gratitude, thanking me for coming from so far away to help in the despair?

I ask God, "Why?" Why did all the children in a primary school at 8am on a Sunday morning die as they were swallowed by a giant wave? Why did all the patients in one hospital perish as mud engulfed them as they lay in their sick beds? Why are 170,000 men, women or children dead or missing, presumed dead in Aceh atone, because of this disaster? Again, I have no words.

Together, we struggle to find meaning and hope amid the sadness.

Ruth Cooke, RN, BHSc, works as a public health nurse at the Hutt Valley District Health Board. She spent March working in Banda Aceh with the Christian organisation Servants to Asia's Urban Poor. For those interested in learning more about Servants' work in Banda Aceh, contact Cooke on email [e-mail].