1. Nicoll, Leslie H. PhD, MBA, RN, BC
  2. Gorman, Linda RN, MN

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On December 26, 2004, deep in the Indian Ocean, 200 years' built-up pressure was released when the subduction zone between the Indian tectonic plate and the Burma plate slid. The result was an earthquake that measured 9.3 on the Richter scale, the second strongest earthquake ever recorded. At the moment of release, the earth ripped open along the fault line even as it wobbled for a second on its axis of rotation.


The quake triggered powerful tsunamis reaching 10 meters in height, and these moved outward through the Indian Ocean at over 500 kilometers an hour wrecking coastal areas in India, Indonesia, Sri Lanka, Thailand, and Maldives, as well as in Myanmar, Seychelles, and Somalia. More than 200,000 people died in the floods that ensued; hundreds of thousands more are missing or displaced. In some villages, entire generations were instantly wiped out. This will surely affect future generations in ways we cannot imagine now.


The world responded to the tragedy with outpourings of aid, donations, and volunteers. Immediate efforts helped to prevent epidemics of diseases such as cholera and malaria. Survivors are finding homes in refugee camps, schools have been created, and a beginning normalcy is starting to return to the affected countries.


Still, much remains to be done. Disasters such as the tsunami often produce "incomplete" rescues for the victims. An incomplete rescue is one in which the long-term psychological consequences affecting the survivors of a tragedy are not fully addressed. Naturally, in the immediate postdisaster aftermath, the main focus of the rescue must be on the physical, life-preserving efforts of trauma intervention. However, too much focus on the physical issues and no attention to the psychological issues may result in life-long negative health consequences. As hospice and palliative nurses, many of us have seen firsthand the effect of incomplete grieving or bereavement on families and loved ones.


As the headlines fade and the cameras move on, thousands are potentially at risk. Fortunately, many aid agencies do have long-term plans for rebuilding both homes and lives. The UNICEF has stressed the importance of sustained counseling for the survivors, especially children. Save the Children has both large-scale and smaller-scale efforts planned, with timelines ranging from 1 month to 5 years. (See for details on these efforts.) The Salvation Army is committed to continue to meet immediate needs in South Asia while transitioning into the long-term reconstruction and rehabilitation programs. In their words, "The Salvation Army is often among the first relief agencies to arrive at the scene of a disaster and almost always the last to leave." 1


The Hospice and Palliative Nurses Association is also committed to these long-term efforts. It realizes the importance of rebuilding infrastructure and providing counseling and support to all of those affected by this disaster.


As a member of HPNA you may ask, "What can I do?" At this juncture, your best response is still the same as it was at the beginning: make charitable donations in the form of money. The Center for International Disaster Information is quite explicit when it says, "Financial contributions allow professional relief organizations to purchase exactly what disaster victims need most urgently and to pay for the transportation necessary to distribute those supplies. By purchasing exactly what is needed, relief agencies can avoid the oversupply of what is not needed and the purchase of those urgently needed commodities which might be in short supply[horizontal ellipsis]. Cash contributions to established legitimate relief agencies are always considerably more beneficial than the donation of commodities."


Now that the immediate recovery period is over, you can take some time to research aid agencies and select one that has a long-term plan that corresponds to your charitable goals. For example, the Free Wheelchair Mission ( will be sending 2750 wheelchairs to India and Sri Lanka by April 2005. The International Lions Clubs, through the Lions Club Foundation, will be working in South Asia to rebuild homes, schools, and child welfare centers for orphans and to provide for psychological treatment and physical rehabilitation for children and emotional counseling for adults ( In Sri Lanka, a charity organization, the Samaritan's Purse, is providing dozens of small boats and nets to replace those destroyed by the giant waves. Each boat will put several fishermen back to work, furnishing food and a livelihood to support their families ( These are just a few examples. The US Agency for International Development (USAID) has detailed information on relief agencies, their funding mechanisms, and their long-term plans for tsunami relief to aid you in your decision making (


Like the aftershocks of the earthquakes, this is a tragedy that will continue for years to come. We encourage all HPNA members and JHPN readers to remember the victims and be generous in their giving.


1. Salvation Army. Salvation Army moves into lengthy rehabilitation and reconstruction phase in tsunami affected areas. Available at: Accessed February 18, 2005. [Context Link]


2. Center for International Disaster Information. Frequently asked questions regarding international disaster relief. Available at: Accessed February 18, 2005.