Pottuvil, Sri Lanka -- In front of a roadside tent he made from wooden poles and a sheet of plastic, P.S. Thiaugansalen swung a heavy hoe into the soil, to dig a pit to bury his garbage.

An attendant at nearby Komari hospital, he was just eight months from retirement when the Dec. 26 tsunami destroyed his home and flattened the medical clinic.

Now, he has joined 330 other displaced families at Komari One, a tent camp that sprang up days after the disaster - and that may be his home for months to come.

"I lived in a big house,'' he said proudly, his bare chest glistening in the tropical morning sun. It was worth about $10,000, he calculated, a lifetime of work lost in an instant. His family, at least, was saved.

Pottuvil and its surrounding villages are a predominantly Muslim, Tamil- speaking community of fishermen and farmers that had begun to blossom as a tourist center. Surfers had declared some of the beaches just south of here to be among the best in the world.

But tucked against a wilderness area on the southeast coast, the region lies at the far end of the international relief chain. Nearly a month after the disaster, serious help has only now begun to arrive for its 5,000 tsunami refugees.

At Komari One, evidence of that help is everywhere. A Finnish Red Cross team has built a camp of crisp and clean white tents to house a health center. Trucks rumble by and stop to drop sacks of rice and boxes of tea at a shed built of shiny, corrugated tin.

Three German doctors, who had decamped from a weeklong stay at Paraliya, where the tsunami swamped a passenger train, rolled up in a van with an offer to help here next.

On a sweltering Saturday morning, Dr. Vaji Dharmasena, a Kaiser Permanente gynecologist from San Jose, set up a women's health clinic in a green tent, and a line of pregnant women was soon at her door. She and Swanthi Samarakkody, a Kaiser Oakland pediatric nurse, have been in Sri Lanka for a week and have run clinics at 14 different relief camps.

The temperature inside the tent quickly rose to 95 degrees. Dharmasena calmly inquired - with the help of an interpreter - about the women's condition, their symptoms and their complaints.

"The baby is OK," she assured one woman in a white dress who had listened to the sound of her fetus' heartbeat on a portable electronic monitor the doctor had brought from California.

Another woman, in her early 20s, was pregnant with her fifth child. "You ought to think about family planning,'' the Sri Lankan-born doctor said. The young woman at first looked puzzled, queried with her interpreter, and then slowly nodded.

The women at Komari One also sought help for aches and pains, fevers and infections. Dharmasena referred them to Samarakkody, who worked with a local pharmacist to mix and dispense drugs.

"I have never seen so many fungal infections in my life,'' Dharmasena said.

After she had attended some 60 patients in four hours, a truck drove up with volunteers offering bottles of a re-hydration solution formulated for children. "This is welcome!" Dharmasena beamed. "I see a lot of babies that are dehydrated."

When the visitors explained that the sponsor of the offer was lingerie retailer Victoria's Secret, the doctor joked, "I would think you should have provided panties for the women!"

In fact, the men said, they could supply that too. Dharmasena was genuinely pleased. "I am a women's doctor," she explained, "and the women need this. I could give a pair to each of my patients. People are giving us everything here, except underwear."

There is no shortage of outer garments in this tropical refugee camp, but the choices are sometimes odd. Among a group of children playing in a tractor trailer, 10-year-old Darmasilan was dressed in a donated pink snow jacket, while the temperature hovered around 85 degrees.

Dr. Mohamed Sameem, director of Pottuvil's public health services, has drawn up a list of what his district really needs from the Sri Lankan government and the international relief agencies. He needs 3,000 mosquito nets. He needs 400 portable toilets. He needs help to restore 450 wells. He needs more tents, more chairs, more exam tables.

Medicines are still in short supply.

"If we ask for 10,000 doses of amoxicillin (an antibiotic), they give us 2,000,'' he said.

The big district hospital survived the wave, but community hospitals in Komari, to the north of Pottuvil, and in Ullai, just across the broken Arugam Bay bridge to the south, were destroyed. Hospital employees' lives were spared in the disaster, but many of them are now homeless.

No major outbreaks of disease have occurred, but after heavy tropical rains, there are mosquitoes breeding in mud holes, and while the relief camps are well equipped with tents and trucked-in water, there is a lack of latrines.

Life in a relief camp is a routine of waiting: waiting for food, waiting for medicine, waiting for the next rain, waiting for the next truck, waiting for a new home and a way out.

On a slight rise at the south end of the camp, a wiry laborer named Jauaraja forms a bowl of sand, pours in some cement mixture, adds water, and stirs. It is mortar for the rough bricks that will become Komari One's first toilets.

It's an awkward project to discuss, but the residents say they are forced to relieve themselves on the paths leading out to the sea.

After so many weeks of being surrounded by rubble, something is being built again. With brick and mortar, the new latrines at Komari One bring a measure of hope, and an uneasy sense of permanence.

Kalutara District, Sri Lanka -- Just a few miles inland from the stricken fishing villages, Dr. Vaji Dharmasena hiked up the steep road to Veheragala, a hilltop Buddhist temple now home to 80 families whose houses were bashed to pieces by the sea that once sustained them.

A Kaiser Permanente obstetrician/gynecologist in San Jose, Dharmasena and two Bay Area colleagues had joined a busload of 30 doctors and physicians from the capital city of Colombo for their first visit to the communities devastated by the Dec. 26 tsunami.

The chartered bus snaked its way up the dirt road to Veheragala in sweltering heat until the road became too steep, and then the doctors hoofed it the final quarter-mile to the top. There, under the shade of a large square pagoda with a commanding view of coastal communities below, families have strung brightly colored sheets to cordon off some private space, where they nurse their wounds and their grief.

"This is an opportunity to do some good work,'' said Dharmasena, a Sri Lankan who grew up in Colombo, came to the United States as a Stanford undergraduate and eventually became a doctor and the mother of two.

On the day of the earthquake and tsunami, once she had learned her own family was safe, she began e-mailing top Kaiser physicians for permission to help her stricken country, where the death toll has reached 31,000. Now, she and emergency medicine specialist Dr. Hernando Garzon of Davis are the first of dozens of Kaiser doctors who, over the course of the coming year, will take time to assist tsunami victims here. Kaiser is underwriting the entire program from air fare and accommodations to salaries.

Organized by prominent Colombo physician Dr. Lakshman Weerasena, the convoy of doctors visited two sites Sunday, both of them Buddhist temples converted into refugee camps. They would give the men, women and children medical checkups and donated drugs and toiletries -- for many the only possessions they would have now.

Stories of loss and survival abound here. K.K. Iresha, of the fishing town Paiyagala, has lost her home. "The house is down. We lost our boat. We lost our gear," she said. But her husband, brother, sister, father, mother and her grandparents were safe.

G.K. Ariugis, another homeless refugee, lost her grandfather in the surging water.

Without the prospect of rebuilding soon, the refugees are mulling their fate, hoping to move in with relatives, facing an uncertain future. This day, at least, was different. People were bringing medicine.

Swanthi Samarakkody, a Kaiser Oakland pediatric nurse, was on hand to help. She had flown to her parents' home on her own initiative a week earlier. She came to the United States at the age of 19, attended Contra Costa College and earned a degree in nursing. She joined Kaiser three years ago after stints working in a nursing home and at UCSF.

Her parents were lucky: The Boxing Day tsunami, as it is called around here, had lost the fury of its assault by the time it reached their neighborhood, near the Indian Ocean in a town just south of Colombo. The wave that rolled up to their doorstep was a modest five-foot surge.

Earlier Sunday morning, the traveling medical group had set up shop at the Dodangoda temple, a large complex just a mile or so from shore and north of Veheragala. Hundreds of children, refugees and people from the community in need of care lined up to consult with the doctors, who had set up tables in the shade of a pagoda.

Dharmasena brought with her an electronic stethoscope, so her first patient -- 23-year-old pregnant tsunami refugee Milmini Perera -- was able to hear the sound of her child's heartbeat. "She did not know the baby's due date, which is probably February 3rd,'' Dharmasena said.

The smell of betadine wafted through the pagoda as the medical team checked off prescriptions for antibiotics and anti-fungals and cleaned and taped infected wounds. For the Kaiser group, it was a warm-up for the work to come. They will be setting out on their own to the hard-hit Ampara district on the east coast, where 10,000 people died and refugee camps house thousands.

"There are many phases in disaster relief,'' said Garzon. "The first is to deal with trauma. The second is to deal with injuries to people who fall off ladders, step on a nail or become ill because they have just run out of things -- their medications, their food.'' A third phase, lasting longer, may occur when diseases such as cholera, typhoid, tetanus and malaria spring up because of the broken public health and sanitation infrastructure.

Garzon is a member of the federally deputized Urban Search and Rescue team. He has been regularly dispatched to handle medical problems after hurricanes and floods. He rushed to Oklahoma City to tend to the injured after the federal building was bombed in 1995, and was on site at the World Trade Center after Sept. 11, 2001.

Garzon and Dharmasena hope to scout out needy sites in Sri Lanka, to find a place where Kaiser doctors can rotate in and out in two-week intervals for the next year.

Dr. Lucien Perera, a Colombo surgeon who has been riding convoys to the stricken areas since Dec. 27, said he has been impressed with how his countrymen and the international community have responded so far.

"I suppose you need a big disaster to get the best out of people,'' he said.

On the long bus ride back to Colombo, Garzon dialed up his Davis home on a portable satellite telephone. He heard some good news. His two boys, Graham, 9, and Clay, 11, had gone door to door in their neighborhood. They had just raised $246 for Sri Lankan relief.

A pair of Kaiser Permanente physicians is jetting off to Sri Lanka today, the vanguard of what promises to be dozens of doctor volunteers who will attempt to help the island nation recover from the disastrous tsunami that killed 30,000 there.

Dr. Vaji Dharmasena, a Sri Lankan-born obstetrician-gynecologist at Kaiser's Santa Teresa Medical Center in San Jose, and Dr. Hernando Garson, an emergency room specialist from Sacramento, will be scouting out medical needs in hard-hit coastal towns and inland communities that have sprouted refugee camps for newly homeless tsunami survivors.

"This is just the beginning of Kaiser Permanente's efforts,'' said Dr. Robert Pearl, chief executive of the medical group, at an Oakland press conference. "We'll be sending teams based on the need and their expertise.''

Kaiser has already donated $1 million in cash to a variety of relief agencies.

Throughout southern Asia, an estimated 150,000 people died when a magnitude 9.0 earthquake off the coast of Sumatra generated waves that swept across the Indian Ocean, killing tourists, fisherman and coastal dwellers from Indonesia to Somalia.

More than 200 doctors from the Northern California medical group have volunteered to spend time in the disaster zone. Throughout the year, Kaiser expects to send from 50 to 100 doctors, who will rotate in shifts of two weeks to one month.

Kaiser is underwriting the cost of travel and accommodation for the physicians, as well as donating medical supplies and the doctors' time. There are about 5,000 doctors in the Northern California medical group, so Pearl said there would be minimal impact locally while the physicians were away.

Teams of two to six physicians will rotate in and out of Sri Lanka for 14- day tours of duty. In addition, infectious disease specialists will be dispatched for monthlong stints to Banda Aceh, in the hard-hit northern province of Indonesia, where more than 100,000 are believed to have perished.

Dharmasena's parents still live in Colombo, the capital of Sri Lanka. None of her immediate family was hurt in the disaster, which was confined to eastern and southern coastal communities, but in this small nation the impact of the tragedy is universal. "Everyone in my family knows someone who died, who lost their home or lost their business,'' she said.

Her own children have also spent time in Sri Lanka, playing on beaches where entire families were swept to their deaths when the tsunami arrived.

Garzon is a veteran of the Sacramento-based Urban Search and Rescue Team. He was among the first dispatched to Oklahoma City after the bombing of the federal building there in 1995 and to the site of the World Trade Center after Sept. 11.

"We'll be going over there with duffel bags of medical gear,'' he said.

Health concerns in the affected areas range from treating broken bones and cuts of those who lived through the horrifying events of Dec. 26, as well as preventing outbreaks of disease such as measles, cholera and malaria that can accompany a disaster of this magnitude.

Dr. David Witt, chief of infectious diseases for Kaiser's Northern California region, will leave next week with two other Kaiser doctors for Banda Aceh, where they will link up with a British organization, MENTOR, to train survivors in malaria control.

"We've seen a breakdown of basic malaria control there,'' said Witt. "Mosquito abatement has vanished. The public health agencies are dead. Their sprays are washed away.''