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MEULABOH, INDONESIA (7 March 2005) - Since reopening a month ago, the puskesmas (health clinic) in Johan Pahlawan sub-district, Meulaboh, has been trying to cope with a depleted staff and limited medical equipment and supplies.

Dr. Marwan, the clinic head, stands before a rear wall that was destroyed during the earthquake and tsunami that pulverized much of west and northwest coastal Aceh province on December 26, 2004. Large parts of Meulaboh, a bustling market town, were devastated.

The clinic, supported by an ADB-financed decentralized health services project, was forced to close down after its premises were covered in thick debris, its equipment damaged and medication spoiled, says Dr. Marwan.

"Six of our staff of 66 died and others have gone to Medan and other places," he says.

"This makes my job difficult, but I cannot put pressure on my staff, who lost family and homes, and who need counseling."

Adding to Dr. Marwan's difficulties, the clinic, which used to serve 21 villages before many were wiped out, may have to move under new rules requiring health centers to be at least 2 km from the coast.

The clinic is one of 240 health centers that were wholly or partially damaged by the calamity, according to the Ministry of Health. One third of Aceh province's health centers were affected. Total damage to the health sector is estimated at $82 million, according to a joint government-donor assessment.

"Since we have an ongoing project in Aceh province that targets the poor and vulnerable, especially children and women, we have been able to quickly identify funds of US$13 million, such as loan savings, that can be used to help tsunami-affected areas," says Yukihiro Shiroishi, an ADB Health Specialist.

In addition, ADB is discussing with the Government a substantive grant assistance package from its recently established ADB Asian Tsunami Fund to repair and reconstruct health facilities and to provide equipment, transport, management support, and capacity building.

"Some of our assistance is also expected to go towards providing counseling therapy for those who have been traumatized," says Mr. Shiroishi.

Experts say the greater long-term problem - and one less treated - is the trauma associated with calamity.

On the verandah of the Johan Pahlawan clinic, midwife Fitriana, 31, says she was holding her baby girl when the tsunami "came at us from the front and struck like a cobra."

Holding up her hands to illustrate the point, she says the impact knocked her over, forcing her to relinquish grasp of her daughter, Alfia, whom she never saw again.

Although Fitriana tells her story calmly, two women listeners are in tears.

Fitriana says a 6-year-old girl daughter, Talita, survived but is still traumatized.

"She wouldn't leave the upstairs part of a house for weeks, and she cries whenever it rains or the sky becomes cloudy," says Fitriana.

In the aftermath of the disaster, there were fears of outbreaks of diarrhea, acute respiratory infections, measles, and malaria. But these were stemmed by foreign and Indonesian teams implementing vaccination and "fogging" (spraying with disinfectants or insecticide) programs as well as the provision of essential drugs and oral rehydration salts.

At the Meulaboh general hospital, which has also received ADB assistance, operations are slowly becoming more normal after a period of intense pressure.

Dr. Haris Suputra, the hospital chief, recalls the pandemonium caused by the giant wave that brutally killed tens of thousands and totally up-ended the lives of survivors.

"As soon as I felt the earthquake, I rushed to the office," he says. "The hospital is near a major intersection and people began running in the streets and screaming, 'Water is coming!' This caused panic in the hospital and some patients fled while I was treating them. Others left in wheelchairs and some in beds pushed by their families."

In the days that followed, Dr. Haris hardly left the hospital as the influx of patients soared fivefold to 500 a day. He also had to cope with a staff reduced by 80% - through deaths and homelessness - and with limited medication.

On the walls of the hospital are lists of survivors, alongside photographs of missing people posted by relatives. People come all day to scan the lists anxiously. They arrive with hope, but most leave without closure.

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