The Cape Negrais Relief initial reconnaissance and relief mission to Cape Negrais and Alekyun (;Middle Island>) and the surrounding areas in the western Ayeyarwaddy Delta, was the first outside assistance to reach many isolated villages in the area following the devastation of Cyclone NargisD local officials had already, from the first days after the cyclone, been actively surveying damage in the area and providing limited immediate relief to survivors.

Dr. Ye Moe Myint, Assistant Director of Medical Services at Pun Hlaing International Hospital in Yangon was one of the leaders of Cape Negrais Relief's first reconnaissance and relief team. While in the Delta, the Cape Negrais reconnaissance team met with the local community leaders as well as township medical staff and surveyed the devastated area to understand the most pressing needs following the cyclone. Dr. Ye Moe Myint in the Delta

Of the various rural healthcare centers, also known as ;station hospitals> that existed in the Delta before the devastation of Cyclone Nargis, many have been significantly damaged, if not, totally destroyed. The station hospitals are the normal basic medical infrastructure of the Ministry of Health where a team that includes both doctors and nurses, provides basic healthcare for the rural community. Station hospitals are generally supplemented in rural areas by mobile teams of midwives and paramedics who provide care in smaller villages. Patients with serious illnesses have to be transferred to district general hospitals for treatment- the nearest to Alekyun is in Pathein.

Hainggyi Island's Destroyed Hospital

Dr. Ye Moe Myint, U Min Oo & U Hla Aung

Repair and reconstruction of the DeltaKs seriously damaged health infrastructure needs to be fast tracked in order to allow normal healthcare service delivery to resume. In those areas under Cape Negrais ReliefKs remit where damage is less, this process has now begun. Roof repairs have been fast-tracked and the Cape Negrais teams have been assisting in this task. In areas of greater damage, it has not been possible to do more than a limited amount. In view of the catastrophic devastation in the Delta, in any event, it is unlikely that the pre-existing setup will fully provide for the day-to-day healthcare needs of the community in the foreseeable future and that medium to long term assistance will be required.

Hainggyi Island Survivors

Hainggyi High School Housing a temporary outpatient clinic moved from Hainggyi Island's Ruined Hospital - 2 doctors and 3 nurses for the island (Pop. Est. 13,000)

The Cape Negrais Relief medical teamsK focus has been principally on Alekyun and surrounding areas. Alekyun, (est. population Q0,000), had two station hospitals before the cyclone. The roof station hospital located at Magyipin in the north of Alekyun was Q0-80T destroyed by Cyclone Nargis. The roof of the other station hospital at Pyinkayaing, in the south, was also damaged. Two local midwives died. After de-briefing the initial reconnaissance team that arrived back in Yangon on May 14, Cape Negrais Relief agreed to dispatch volunteer medical teams to treat survivors of the cyclone. Pun Hlaing International Hospital agreed to lead the Cape Negrais medical relief teams. Yangon medical professionals were Puick to volunteer. A team of over 100 local volunteer doctors, nurses and support staff was rapidly put together.

Cape Negrais Medical Team departs from Yangon

Ngaputaw nurse, Dr. Ye Moe Myint, Magyibin Station Medical Officer; Dr. Myo Myin Swe, Dr. La Min Than Cho

A two day crash course in disaster medicine was arranged for the volunteer medical teams by Pun Hlaing International Hospital, with support and teaching provided by teams from Mercy Malaysia, Save the Children and HUMA Xapan and Israel's IMPULSE.

On 21st May, the first medical team consisting of Dr. Ye and a team of medical volunteers, (7 doctors, 4 nurses, 1 pharmacist and 4 support staff), left Yangon, travelling by road to Pathein and then by boat onto Cape Negrais and Alekyun.

The team carried with them boat-loads of medical and other supplies. These supplies were donated and acquired locally in Yangon, as well as being given by overseas donors and agencies. They included items from overseas donors on shipments into Myanmar assisted by Cape Negrais Relief.

The first Medical Relief Team established a base at Thingangon at the centre of Alekyun, after planning with the local Township Medical and Township Officers and working in conjunction with their counterparts in the Cape Negrais logistics and construction teams who were already working in the area. Initially in the first few days, the medical team worked out of an existing building.

From May 27, the Cape Negrais medical teams have been working out of a prefabricated building brought in and erected by the Cape Negrais teams in the grounds of a school.

Blessing Ceremony at Thingangon Medical Base	Patients queuing to see the doctor at our newly erected Thingangon Medical Base

Dr. Ye Moe Myint visits Magyipin Hospital

The previous day, May 26, the pre-fabricated medical base had been completed and a blessing ceremony performed by local monks. The Thingangon medical base supplements the limited care the damaged station hospitals at Magyipin and Pyinkayaing are now able to provide. Volunteer reinforcements of the medical team have been dispatched regularly from Yangon. Currently, the team totals 11 doctors, 8 nurses/HCAs, a pharmacist and support staff. For the time being, volunteers are rotating to spend approximately 2 weeks at a time in the field, providing assistance to the survivors of Cyclone Nargis. The third team returned to Yangon on June 10th and a fourth replaced it.

Thingangon Temporary Clinic	Local Doctor's Clinic

Mobile medical teams have begun operating away from the Thingangon base to provide basic community medical care at free out-patient clinics in other villages. The Cape Negrais medical teams have been operating mobile clinics at six placesD Magyipin, Chaung Wa, Thet Ke Thaung, Kyauk Chaung, Zee Phyu Seik, and Atetpyunwa. These mobile clinics are operating from lesser damaged buildings provided by local people, as well as in Cape Negrais ReliefKs pre-fabricated buildings. Gifts of Malarial Packs to Magyipin Hospital

At the town of Magyipin, a prefabricated building has been set up by the Cape Negrais construction team in order to provide supplementary facilities while the station hospital there undergoes repairs.

Going to Ze Pu Zeik

Medical team arrives for Kyauk Chaung Mobile Clinic

Volunteer doctors and nurses from the Cape Negrais team are now treating over 280 patients a day, working daily, from early to late, in difficult conditions. Patients arrive at the clinics at dawn from the surrounding area and queue patiently waiting to be seen.

A few patients have received treatment for wounds sustained in Cyclone Nargis and the cleanup afterwards. (Casualties with serious injuries had previously been evacuated and transferred, mainly to the district general hospital at Pathein.) Others seek treatment for pre-existing conditions such as hypertension and diabetes.

Many more patients need psychological counseling for the traumatic experiences they have been through and their personal loss: in some villages in Cape Negrais and Alekyun over 40T of the village populations perished in the cyclonec many villages in the south and eastern coastal areas of the island have been totally destroyed and others further inland seriously damaged.

Fortunately, to date there is little sign of any severe outbreaks of infectious diseases although dengue is endemic on Alekyun, as in much of south east Asia. Alekyun has a relatively low incidence of malaria. It is more prevalent in other areas but the malarial peak in the Delta generally occurs at the end, rather than the beginning of the rainy season. Dr. Tun Wai and Pharmacist, Than Than Htut dispense medicine

This year's rainy season began after the full moon last week and, for the time being, there is little still water for mosquitoes to breed. Nevertheless, the teams remain vigilant. Dr. Tun Wai sees patients

Currently, the biggest problem for public health is the swarms of flies and other insects. Some of these insects bite, with the resulting wounds being itchy and easily infected. Team on the way to open a mobile clinic

Dr. Ye Moe Myint at Thingangone

Thant Zin Oo registering patients at mobile clinic

The insect problem has been made worse this season by the rubbish and other debris left behind by the cyclone. To deal with the extent of this public health problem require concerted, larger scale efforts. The local authorities and village headmen have begun working in conjunction with the Cape Negrais Relief medical team to raise awareness of this issue and organise clean-ups. Cape Negrais Relief is dispatching a professional pest control team of GITE from Yangon to Alekyun to spray against insects.

On a happier note, Thingangon medical base celebrated the birth of its first baby on June 9th: both mother and baby boy are doing well. As the existence of the Cape Negrais Thingangon medical base becomes better known among the community, patients are coming to seek help from further afield. In addition, emergency cases are now being brought to the medical base, 24 hours a day.

First Baby born at Thingangone Medical Base

Dr. Ye Moe Myint and Daw Mar Mar Aye administer a Rapid Diagnostic Test for Malaria

Cape Negrais Relief has begun considering how to best assist in the refurbishment, reconstruction and provisioning of the healthcare infrastructure of Alekyun and the surrounding areas for the longer term, working in conjunction with the local authorities towards the goal of restoring normal healthcare provisioning for the Delta community.