1. Introduction
   
2. Preparation
   
3. Field Activities
   
4. Debriefing
   
5. Identified Needs for the future
   
6. Profile of team members
   
7. Supplies
   
8. Coordination with other groups
   
9. Future Plans
   
10. Thoughts
    
11. Acknowledgements

Introduction:

St. John's has always lead what is well known as the "Bangalore Response" to disasters in the Indian Peninsula since the early 1970s. They have sent teams to the West Bengal War Refugee Camps 1971; Andhra Pradesh Cyclone 1977; Bhopal Gas Tragedy; Bangladesh Cyclone 1991; Latur Khillari Marathwada Earthquake 1993 and, as recent experience will indicate, been proactive in sending 3 medical teams to Orissa in the aftermath of the devastating cyclone in the October-November 1999. Medical personnel (General Physicians, Surgeons, Epidemiologists, Pediatricians, Orthopedicians, Ophthalmologists, Nurses) numbering 32 divided into three teams worked over a period of over one month providing care for people effected in areas of Paradeep, Jagatsinghpur and Ersama areas of Orissa. These teams worked along side various organizations including Service Civil International, Action Aid, Medici sans Frontier, Community Health Cell, and Catholic Hospital Association Of India and even along with the Indian Army. Work included not only medical preventive and curative measures, but more important work of clearing carcasses, chlorinating wells, education, food, clothing and shelter material distribution as well as initiating rehabilitation programs.Each team spent 7-14 days (depending on a field need base) in the field overlapping to ensure a continued intensive cover to areas most in need. It was following these experiences that St. John's Medical College started the first and only Medical College Disaster Relief and Training Unit in late 2000. It is this Unit that forms the catalyst for encouraging and planning manpower needs for disaster relief teams, as in the present Gujarat scenario. Bangalore as a city has always responded positively especially since the media has brought disasters literality into the living room.

Preparation:

As soon as news reached, a volunteer list was activated and persons selected to form the first team. However, on the 27^th January 2001 the Government of Karnataka (Director of Medical Education) requested for assistance in sending surgeons, anesthesiologists and orthopedicians into the field. The St. John's team was then divided into two, one to proceed with the Government team and one to proceed individually. Financial backing was sought through a friend of St. John's and Coordinator "Child for Life Fund", Ms Parveen Sikand. A pharmacy list was activated which was a modified WHO Essential Drug List according to field need information available at that time. To strengthen the team's non-dependence on local stressed resources, tents, rucksacks, sleeping bags, food and water were also arranged. Oxfam's Disaster Relief Team Coordinator, Mr. Unnikrishnan, assisted us in locating local contacts willing to guide us into the field. The local contact identified was the Janvikas group, which was part of a coordinated NGO effort called the Janpath Citizen's Initiative. By the 27^th January, volunteers, medical supplies, team logistics, financial commitments and a local network contact were in place.

Field Activities:

To fulfill our commitment to our government, our first three volunteers on their request flew on the 28^th January 2001. They were to work under the Government of Gujarat's Relief Commissioner in Government Hospitals in the effected areas. All three, Drs. Sanjay Joseph (Orthopedician), John Marianand (Anesthesiologist) and Bijay Agarwal (Surgery) have completed a hectic ten days in Patan General Hospital. They operated around the clock and lost count of all the plasters and dressing they completed during the stay. During the initial 3-5 days they averaged 20-25 surgeries per day individually and took care of ten wards (Hospital and Tents) allotted to them. They were so conscientious that their services were extended till the 8^th February 2001. Now all emergency surgeries have been completed and only elective procedures are pending. The Karnataka team lost only one patient in spite of their busy schedule, which tells of their affectivity in the field.

The main team of the remaining 10 medical personnel from St. John's flew to Ahmedabad on the 29^th February. They carried over 1.6 ton of WHO essential medical drugs which included surgical supplies and basic resuscitation equipment based on available field requests for help. They proceeded to the Janpath Citizen's Initiative control room at the JanVikas offices at Ahmedabad and then into the field. The team was totally independent with tents, sleeping bags and rucksacks as shelter. Food and water for 48-72 hours was also carried in for the team's survival till base of established. The team made its journey by road to Radhanpur, Rapar, Neelpar and finally Bhachau. They held roadside clinics and also surveyed interior areas to identify areas not visited by anyone. Finally at Bhachau they camped along side the Indian Army Field Hospital and independently manned the Army camp Outpatient, assisted with nursing and medical care of Inpatients and with surgery and anesthesia for procedures. Communication was set up once our own Koramangala 70-year-old resident Mr. Ramachandra, a HAM enthusiast, joined the team after driving the entire distance from Bangalore. The work predominately included trauma related orthopedic problems like fractures, limb and pelvic which needed conservative and operative procedures. Wounds needed dressings and infections had become common. Failure of the provision of temporary shelters has exposed the displaced population especially women and children to the cold and wind causing acute Respiratory illnesses like Pneumonias. Sanitation and unprotected water supply are problems, which in turn has lead to diarrhea in a few cases however this is predicted to rise with the failure of protection of drinking water sources once the packet water supply is stopped. Prior to reaching the Bachau Army Field Hospital, roadside clinics accounted for around 30-50 patients per clinic, which was 1-4 times a day depending upon needs of the local population. At Bachau, a coordinated effort of two clinics and dressing rooms were set up opposite the Field hospital. Here an average of 100 -120 patients were seen with minor trauma, post injury care and health problems secondary to exposure and poor sanitation. The Army Hospital across the road was handed over to the team to run and here 160-190 patients were seen per day. Our Orthopedician, Anesthesiologist and Surgeon were welcome help in the field hospital operation theater were they assisted the team with dressings, reduction of fractures, plaster applications, both casts and slabs, debridement, amputation, disarticulations and minor non trauma procedures. Over the next five days the patients cared for in this area numbered 392. Of these, 125 procedures were performed under General Anesthesia by our team as it worked in tandem with the field hospital. On the 4^th February 2001, with number of patients needing help rapidly dwindling and the presence of numerous other teams in the area, the team leader and the team took a decision that they were no longer needed. They were escorted back to Ahmedabad and flown out after a debriefing on the 5^th February 2001.