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Nurses like Marie Davis, RN, pictured here on missions to Afghanistan and Liberia, volunteer their clinical skills to nations in need. Davis will be heading out to help deliver health care to South Asia’s earthquake/tsunami victims in February.

Marie Davis, RN, has worked in countries stricken by floods, hurricanes, earthquakes, famine, and war. When disaster strikes abroad, the Salem, Ore., mother of two begins packing her travel bag.

An emergency care nurse for 24 years, Davis is brushing up on infectious diseases for what in late February will be her 38th mission — to provide medical aid and comfort to survivors of the devastating tsunami in the South Asia seas as a volunteer with Northwest Medical Teams.

Swanphi Samarakkody, RN, a pediatric nurse at Kaiser Permanente Oakland (Calif.) Medical Center didn’t wait for a spot with an organized disaster relief group. After the tsunami struck, she booked a flight to the Sri Lankan capital of Colombo, near where she grew up.

“When I saw what was happening, I knew I had to go back and help out any way I could,” says Samarakkody, whose family members survived the tragedy, but the fate of many friends still is unknown. “I know the area, people, language, and customs, so these are barriers I don’t have to overcome.”

Davis and Samarakkody watched in disbelief as the death toll from the Dec. 26 earthquake-generated tidal wave rose above the 150,000 mark. Widespread damage also left about 5 million homeless, hungry, and vulnerable to disease and infection.

Knight Ridder news service reported Jan. 13 that an official document posted in Banda Aceh says nearly 210,000 people inIndonesia are dead or missing, which would raise the toll to more than 270,000.

“As the numbers grew, I began to realize this was a much more catastrophic event than anything I had ever encountered,” Davis says.

She was ready to pack up her mosquito netting, fast-drying clothes, and sturdy shoes and head to the ravaged region, except for one obstacle. All her vacation time had been used on two recent trips — in October, to join a medical brigade in violence-plagued Haiti , and in June, to treat refugees in war-torn Liberia.

Undeterred, Davis negotiated a month off from Salem’s Kaiser hospital, where she works in ambulatory surgery and got a leave from her on-call job in the ED at West Valley Hospital in nearby Dallas, Ore. When she flies out Feb. 24 with a medical team, she believes their services will be needed more than ever to help fight disease, malnutrition, and pneumonia among a population weakened by hunger and stress.

“This is a long-term relief effort and I have enough experience to know that sometimes the first response is not where you’re most needed because the infrastructure to support medical teams is very sketchy,” Davis says. “Medical teams often can’t reach areas because the roads are out. Also, infectious diseases haven’t really hit yet. But they will.”

The aftermath

Outbreaks of diarrhea from drinking contaminated water are on the rise, along with some cases of measles, Davis says. A major job of the volunteer medical teams in the country is surveillance to guard against epidemics of malaria, cholera, typhoid, and hepatitis A.

Although the biggest long-term fear is over waterborne diarrhea-related diseases such as cholera and typhoid, no early outbreaks have occurred, which surprises health workers. A possible explanation is the “salt water bath” from the seawater acted as an antiseptic to kill the bacterial strains, says Lynn Gilbert, RN, PhD, PNP, a certified pediatric nurse practitioner at the University of Colorado School of Nursing who has worked in Africa and the Caribbean.

Gilbert speculates that coastal villagers also might have developed some immunity to low-level exposure to the disease-causing bacteria because of their typical lack of access to clean water.

Once diarrheal disease does strike, however, it can be highly contagious and spread rapidly without a sufficient clean water supply to rehydrate the body of lost fluid, she says.

Although measles isn’t usually fatal, Davis says that secondary infections of the eyes, ears, and upper respiratory system can be deadly, particularly in undernourished children. Pneumonia is also a constant danger in crowded refugee camps that are being pelted by rains.

While Davis calmly waits for her departure date, Samarakkody flew to Colombo on Jan. 10, but not before Kaiser officials asked her to be their advance contact for the first of several medical teams being assembled to go to the region.