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REVIEWS: Penelope Bryant None so naive as the well meaning BMJ 2005; 330: 263 [Full text]

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Yup. You are naive

Nancy K O'Connor   (28 January 2005)

You were unfortunate!

Arri Coomarasamy   (28 January 2005)

Medical Volunteerism in Sri Lanka

Jay Ilangaratne, JS@medical-journals.com   (29 January 2005)

Yup. You are naive 28 January 2005
Nancy K O'Connor, Medical Officer Pawhuska Indian Health Center, Pawhuska OK 74056 Send response to journal: Re: Yup. You are naive	In the middle of a disaster, well meaning people come to help. Sometimes they even "fake" credentials to be able to help. Most aid agencies would need at least to do a basic screeing of credentials, something that would take time and energy away from more vital things, like getting airline tickets for people who regularly volunteer for emergencies and who already have been screened... But even a "well qualified" doctor might be more in the way than someone with experience. The author is a "research fellow" in Paediatrics. Great. Do you know how to start IV's in a dehydrated baby? Place a needle into the tibial bone, do an emergency Saphenous vein cut down? How about a subcutaneous infusion, or an intra abdominal infusion? Can you instruct the mother how to spoon WHO rehydration fluid into her child? And can you do all of these under a tree, or maybe even in a nice tent with lousy lighting? Do you have experience in cholera? Dysentary? Malaria? Tetanus? Schistosomiasis? Dengue fever? Do you speak any of the local languages? Know how to camp out with mosquito netting? Experience in triage? Sterilizing instuments over a small kerosene stove? Suturing with fishline because you ran out of pre packaged Ethilon or Prolene or silk suture material? Can you do emergency surgery using a ketamine drip that is run by a local? Can you instruct local non medical personnel how to do "minor" first aid, like changing dressing? For that matter, do you know how to sterilize dressing, and use old rags to bind them so you can save sterile dressings for using next to the wounds? You do? Great. Give them your credentials, and maybe they will call you for the next tsunami/typhoon/volcano/humanitarian disaster... Competing interests: None declared
You were unfortunate! 28 January 2005
Arri Coomarasamy, Honorary Lecturer in Public Health and Epidemiology and Specialist Registrar in O & G University of Birmingham, UK B15 2TG Send response to journal: Re: You were unfortunate!	Penelope..you were unlucky! Rather the potential victims of tsunami who could have benefited from your charitable services were unlucky! I led a team of three doctors and three nurses within a week of the tsunami to Eastern Sri-Lanka. We were teamed up with two local doctors (who were in fact well-trained medical students) and served a population of 26,000 displaced people, with 8,000 living in 6 crowded camps! Every day we saw and treated between 160 - 200 people, many of whom were very sick. In our absence, most would not have had any medical care. Our regret was that we had to leave after two weeks - however, at the end of our mission, the organisers of our relief work, a well known long-standing charity called Tamil Rehabilitation Organisation (TRO) had sent 3 Malaysian and 3 American doctors to relieve us. You were unlucky that you were not in touch with a charity like TRO. I miss Nancy Connor's point (in the rapid response). You don't need to be a rocket scientist to help. Of the over 1000 people we treated, there wasn't a single person who needed an emergency Saphenous vein cut down - unless you are preparing for a role in ER, such dramatic manoeuvres are not generally needed. To learn to treat common problems such as diarrhoeal diseases (upto 40% mortality in the acute phase of a complex emergency) and respiratory tract infection (account for upto 25% of deaths in under 5 year olds in crowded camps) should not be difficult for anyone with an MBBS. The important point, however, is that the relief doctors only travel as part of a well-managed, centrally co-ordinated effort that is based on an accurate needs assessment. Otherwise, it is very easy to waste your effort. Tamil Rehabilitation Organisation (SL) appreciates that the health care needs will still be there even after the tsunami images disappear from the TV screens, and the big charities have moved on to their next big adventure. Currently TRO are organising a sustained programme to be implemented over the coming year and further on. If you are still interested, please look them up on the web. Competing interests: None declared
Medical Volunteerism in Sri Lanka 29 January 2005
Jay Ilangaratne, Founder www.Medical-Journals.com, JS@medical-journals.com Send response to journal: Re: Medical Volunteerism in Sri Lanka	Dr Bryant need not despair. There are still a good number of opportunities to help the tsunami-affected in Sri Lanka. The Sri Lankan government had set up a Centre for National Operations ('CNO') which co- ordinates almost all aspects of the relief and rehabilitation efforts. Their website [http://www.cnosrilanka.org/index.html#desk] provides a raft of information including the contact details of individuals in charge of various help-desks. I suggest that anyone like Dr Braynt who wishes to volunteer their professional services, contact the psychosocial and/or health desks at the CNO which are manned by qualified medical professionals. In any event, it would now be a sensible precaution to register any interests of volunteerism with the CNO, so the specialist skills of medical volunteers could be effectively utilised whilst ensuring the safety and wellbeing of volunteers at the same time. Competing interests: None declared