10 years on: A reflection on the agony of Aceh

I have made five trips to provide medical relief to the Aceh region, growing my love for the place and it’s people since the first agonising trip. It all started 10 years ago this week, when I left Perth to join the many others helping the devastated Indonesian peninsula.

On December 26th, 2004 at 8 am, a 9.1 magnitude undersea ‘megathrust earthquake’ occurred 160km off the west coast of Sumatra, Indonesia. Sending a 30 m (100 foot) tsunami smashing into the coast of the remote northern province of Aceh and spreading beyond to other coastal Asian countries. Across the region, it killed over 220,000 people and crushed the spirits of the survivors (over 1 million people were displaced). Close to 80% of the deaths recorded occurred in Aceh.

Text I was at home when I heard about the earthquake and tsunami on the radio, then in the local newspaper. But it was a week later when I heard a deeply moving ABC Radio report describing how thousands of kids had become orphans; I listened, I wept for them and volunteered to go and help.

I listened, I wept for them and volunteered to go and help

A good friend of mine, Michael Henderson, organised for me to join an Indonesia NGO called Obor Berkat International through his influential Indonesian contacts. I had six weeks to learn to speak Indonesian – they were working at the coalface and ‘didn’t have a spare seat for a translator’.

Observations from entering a disaster zone

The shock of the first sights
The town I worked in initially was Meulaboh, which was the closest to the epicentre of the earthquake. It was smashed. It was an amazing sight which, as everyone experiences when they see such destruction, is hard to describe. This and similar towns had plenty of awful and strange sights. The destruction was awesome but to walk around and see clothes in the ruins of houses, and kettles, tricycles and toys lying in the mud with no children in sight was to feel the enormity of the personal tragedy, and I wept again.

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  • Example
  • Example
  • Example

Survivor silence
The survivors were not talking to each other about their grief and loss. Everybody had lost somebody dear to them, often many family members. They did not want to create some kind of grief competition, or be disappointed by the lack of empathy from others who have also lost love ones, a recipe for psychological disaster. So we began to ask patients about their tsunami experiences. This was often quite difficult because their experiences were horrendous.

One of our team members told how he had been driving the local Bupati (Mayor) around town to identify a spot where we could build a fishing boat production facility, he wanted to get the fishermen back out on the water and to restore their livelihoods. He asked the Bupati about his tsunami experience, but he was silent. My colleague looked over and saw that the man was weeping. The Bupati told him that he had been driving with his wife and two teenage daughters when the water hit. He had told his wife and daughters to get out of the car and run as fast as they could to get away from it. None of them survived. He had the grief of losing his family, combined with ‘survivor’s guilt’.

Relief team grief
Every team member felt a deep sadness. On one occasion we were feeding two orphans who were living in a small musholla (a muslim prayer building) across the road from the hospital tent. The boys told us their experiences.
They had been playing soccer with a group of other boys down on the front near the ocean when the wave had hit. They described how the wave came at them from three sides as it bent around the promontory. Those of their friends who couldn’t swim drowned immediately. Other boys swam but were killed by bits of wood that were shooting at high velocity through the water like spears. These two boys had survived by continually ducking under the flying wood and other debris. When they finally grabbed onto a tree and the water receded, and they were able to make their way back to where their homes had been, all of their family was dead. Syahrul was 12, and his father and his sister had only just recovered from losing the mother to illness. Now Syahrul had encountered massive grief again. It was impossible not to weep about this.

One 12 year old girl that I saw had experienced asthma since the day of the tsunami. I assumed that she had aspirated something and developed a chest infection masquerading as asthma, or even precipitating asthma but when I looked at her she looked sad and a little bit frightened. She was wheezing but had not had any obvious respiratory infection. Then I found out what had happened during the tsunami. Her mother had gone to the market and had left her in charge of her eight year old sister. When the water had come flooding in she reached out to grab her sister but lost her grip and her sister slipped away, was swept off in the flood and her body was never found. The mother said that the shock of the tsunami combined with the guilt of not looking after her sister, not being able to hold on to her, and having been entrusted with her care caused her to be frightened. She didn’t want to go out anywhere and cried at the sound of rain on the roof of the house. This she felt was why she had asthma. We didn’t have many asthma medications, so I asked them to come back to our base that evening and I would find some. The girl was too scared to do so, but her mother came.

One night after finishing work in the hospital tent I went into my room, shut the door and sobbed uncontrollably for these people, for what they had experienced and were still experiencing. This is common in disaster workers and, if not handled well, can lead to symptoms of PTSD.

It is not so much the massive destruction that causes one to feel sad in disasters, nor even the dead bodies – it is possible to feel slightly immune to that, and as a doctor I have seen plenty of death and dying. It is the feeling of sympathy with the survivors, of the monstrous amount of grief – anyone who has children will sense what that feelings would have been like.

Relief team contribution
My role in Aceh was essentially as a general practitioner, not a lung specialist, because in any post-disaster situation the usual health care facilities, and the capacity to staff them, have been largely destroyed. Therefore people who develop illnesses that would have developed regardless of the disaster have no one to care for them. That is why most of our work is just general medical work.

Text However, I inevitably ended up doing pulmonary work, including management of tuberculosis, aspiration pneumonia (tsunami lung) and general respiratory medicine. I took plenty of opportunities to teach the young Indonesian doctors about management of lung disease and interpretation of chest x-rays. One day I found two completely unused Pentax bronchoscopes, so I also performed bronchoscopies and in the process taught the Indonesian doctors how to perform that skill.

It wasn’t all hard work. We flew around in helicopters and small aircraft that landed on roads and in fishing boats along the coast. I worked with a wonderful team of Indonesians, some of whom still remain good friends 10 years on.

Discussing suffering

When I go to medical seminars to help improve disaster management, the leaders sometimes ask those present about the disaster relief experiences they have had. When I mention Aceh there is a kind of deference given, as though anyone with Aceh experience has ‘seen it all’. The same applies to the Haiti earthquake. I find that sort of Aceh deference also occurs when the notion of suffering is discussed – everyone has an idea about it, including ‘why God allows it’ or ‘what sort of God could ever allow such things, so He/She clearly doesn’t exist’. They don’t necessarily agree with what I say, but I do get a pretty good hearing from that moment. That I have seen that scale of suffering and I am still a Christian.

I don’t have trite answers. But there are two things that keep coming back to me, that drive me on in times of suffering.

  • Reach out in compassion and to ‘weep with those who weep’- don’t search for answers, don’t try and give them and don’t bother asking them when you are in the midst.
  • ‘Better to light a candle than to curse the darkness’ – Chinese Proverb

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