BMJ  2005;330:263 (29 January), doi:10.1136/bmj.330.7485.263

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PERSONAL VIEWS

None so naive as the well meaning

It was a moment of blinding clarity. In the wake of the Indian Ocean earthquake and tsunami I heard on the news that the Sri Lankan government was appealing for paediatricians. It suddenly occurred to me that I might be in an ideal position to go and do something to help, rather than my usual wringing of hands or donating the equivalent of a fraction of a clean water pump. I'm a fellow in paediatric infectious diseases currently doing research, so there would be no patients to miss me, and my colleagues wouldn't be burdened by rota changes. Also, I am financially supported so would not need to be paid, I have previously worked in a refugee situation, and I even already had a ticket for a flight to Malaysia. In my naivety I assumed that charities would be clamouring for my services, so I went to the internet.

Most of the websites had details on how to donate money but nothing about how I personally might be of assistance. I was encouraged, however, by the Red Cross website, which stated that although the charity didn't send volunteers out it did send doctors and nurses. Armed with the telephone numbers from the websites, I started cold calling.

In my naivety I assumed that charities would be clamouring for my services

I began with the British Red Cross, which said that I needed to speak to someone who dealt with overseas personnel and gave me a name and a different number. A young man from something called Crowthorne Associates said there was nobody there of that name and was I trying to get in touch with the Red Cross, as that was the fifth phone call he'd received that day. I called the Red Cross back and spoke to a different man, who spent a long time trying to find out to whom I should speak; and when he failed he said in a regretful tone that unless I was a fisheries expert they wouldn't need my services at present. I am not, so I decided to call Save the Children instead. It was more difficult to find its phone number, as the website directed me to the local Clapham shop, and I wasn't sure that the volunteers there would be able to help. I found a number for the International Alliance of Save the Children, but it couldn't deal with my inquiry and suggested I call Save the Children UK, giving me the phone number I needed. The woman who answered said that they did not need anyone at the moment but that she would take my name and number and someone would get back to me.

Wondering whether I was barking up the wrong tree, I thought that the Royal College of Paediatrics and Child Health might know whom I should contact. A nice woman tried to help me but couldn't offer much more than that the college's response to the disaster would be on its website the following day. She gave me the email address of someone at Child Advocacy International, but the message bounced. Beginning to feel a little despondent, I called Oxfam and began, "I know you're going to say no...," but the woman I spoke to was enthusiastic and said it was a lovely offer, although they weren't currently looking for personnel unless they had experience in public health advocacy (we both agreed that my ability to say "Everyone should be immunised" probably wasn't enough). She suggested that I call Médecins Sans Frontières and Médecins du Monde and found the numbers for both, assuring me that I was just the sort of person they were looking for. Newly encouraged I contacted Médecins Sans Frontières, which said that all its positions were filled. I assumed the same would be true of Médecins du Monde but tried it as my last call anyway. I was told that it had sent out a first wave of its own medical staff but that it would need a second later on, and after a brief discussion someone took my details and asked for my curriculum vitae.

I may not be asked to go, but I learnt two things during this process. Firstly, how difficult it is during this kind of catastrophe to know how to get in touch with the people who might want to use your skills or whom to contact to find out whether those skills are even useful. Secondly, that it's all very well wanting to help, but it is pointless unless it is done in an organised way. The story above belies the longer conversations I had with several people who explained that most of the infrastructure was washed away by the tsunami and that there was no point sending medical staff who couldn't reach anywhere or be able to treat with even the most basic of drugs. That's why organisations such as Médecins du Monde exist, to avoid haphazard reliance on well meaning individual doctors who jump on aeroplanes to go off on their own to save the world. And if they don't need me, I still have a down payment on a water pump to offer.

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University of Melbourne department of paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia penelope.bryant{at}doctors.org.uk

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