Broken forests and ghost-white remnants in Lamno

The first impression of Lamno Town when you see it is that you've stumbled onto a pleasant country farm. Fat geese waddle proudly down the high street. Goats munch, unperturbed, from a spindly tree in the central roundabout.

There is a contented, relaxed, village feel to the air. Even the puskesmas - the district health clinic - fits with this picture. Family members surround patients, chatting, laughing and sharing food. Workmen dig outside. Young children escape from their mothers to tear down corridors, giggling. There is no screaming, no sense of urgency, no panic.

But scratch the surface and the effects of the tsunami soon unfolds. In the sub-district of Lamno, 25 out of 48 villages were washed away. Out of a population of around 24 000, over 7,000 were killed and a further 8,000 are now homeless.

In some areas all that remains of where families once farmed are ghost-white forests of snapped, charred tree stumps. In others, mile after mile of debris have transformed vast expanses into giant rubbish dumps. Amidst the refuse live the displaced.

Every person gathered in the MSF health clinic today has been affected by the tsunami, and has a story to tell. In the men's ward is Buhani, 36, brought in by his mother yesterday for emergency surgery. His chest had been sliced open by a rotating blade. He looks awful.

Before the tsunami this surgery wouldn't have been possible. But, when MSF took over this puskesmas, they quickly rehabilitated it to include an in-patient facility and operating theatres. Now, an Italian anaesthetist and a Filipino surgeon along with their team of national staff conduct operations on a daily basis.

"Many of our operations are for elective surgery," said anaesthetist Giovanni Brescia. "People have survived for years with painful conditions such as hernias and can now finally receive treatment. But with all the heavy reconstruction going on after the tsunami we are also seeing a lot of accidents with machinery."

Buhani is a case in point. I wanted to talk to Buhani about life in the barracks. He lost his wife and children in the tsunami and since then has been housed in one of the many wooden structures that dot the hills. But he looks so ill I dare not disturb him. Fortunately his mother quickly spots my predicament and starts to tell their story.

The entire family - around 20 of them - used to live together in Bakh Paoh village. The mother had a little shop next to their house. The men would farm and fish. Life was hard - this is after all a conflict area - but they managed.

On the morning the tsunami hit almost everyone, save the son, was at home. The family felt the quake, saw the river water recede and fled to the hill behind the house. The mother, one daughter and three grandchildren made it first. They then turned to see the rest of their family along with their entire village smashed by the wave.

We drove out to see where their house was. All that remains are the concrete foundations and a waterlogged tent where the shop once stood. This is now home. All around, similar tents peek out from the sea of mud and rubble. As we seek refuge from the torrential rain and duck pieces of debris flung by the violent wind, the misery is palpable. A little boy, seemingly oblivious to it all, defecates in a puddle by his makeshift home.

Fortunately, there have been no outbreaks of disease. MSF is keeping a close eye on health indicators and outreach teams have reinstated the emergency preparedness system that was destroyed by the tsunami. Mobile clinics visit camps on a daily basis, checking for cases of measles, cholera, malaria and diarrhoea and emergency stocks are being brought on site in case of an outbreak. Hygiene promotion is a priority.

This camp has a permanent medical presence. Behind the grandmother's plot of land gleams the brilliant white of a pre-fab basic health care unit installed by MSF and open daily. It is, explains the grandmother, a great source of comfort. She remembers when MSF first arrived after the tsunami. They came by helicopter with medicine, food and supplies. Their presence makes her feel safer. She is aware of the dangers of disease.

Back in the dry of the MSF clinic the grandmother talks of yet another tragedy. With most of her children dead, two grandchildren now live with her in the tent. She describes them as both 'wild and lonely'.

"I know they need support," she said. "Perhaps someone to talk to. But I am too busy trying to find money to rebuild my shop. We need a source of income to survive. It's so hard and I am an old woman."

MSF is doing what it can to reach out to an entire population traumatised first by war, then by catastrophe. A team of psychologists go out to camps, relocation centres, villages and schools offering a combination of psychosocial education, group discussions and individual counselling. Teachers and health staff are receiving on - going training to recognise common symptoms and a psychologist is available for consultations in the health clinic.

Given that every week patients come to the clinic with psychosomatic complaints, the service is essential. But the needs are overwhelming and, as MSF continues to gain the trust of the people, the number of those seeking help continues to soar.

Since MSF first arrived in Lamno in January 2005, they have conducted 3,011 medical consultations, built community latrines and cleaned wells in every camp, distributed relocation kits containing the basic tools for building homes and held individual counselling sessions with an average of 26 new patients a month. They have done this amongst a cacophony of aid agencies, working hard to attend co ordination meetings and ensure all activities are filling a medical need no one else has met.

As I look at the grandmother carefully tending the dressing of her son-in-law whilst her grandchildren watch on in morbid fascination, I wonder what will become of her and her family. I want to empty my wallet and thrust the contents into her hands. But this is not the answer she is looking for. MSF cannot give her back her old life. But they can save the life of her son and leave behind a health system that can protect her village from the worst of disease.