This is the dismal, desperate scene from which the retired general surgeon, a veteran volunteer with the Aloha Medical Mission, returned Thursday after two weeks at ground zero in Indonesia, the area hardest hit by the Dec. 26 earthquake and tsunami.

In the last week, he has been preparing a team of 10 doctors and nurses, set to depart today on the first in a series of tsunami relief missions.

Aloha Medical Mission, a Honolulu-based charity, was founded in 1983 by Dr. Ramon Sy, who said the coming emergency mission differs radically from the scheduled surgeries the doctors normally perform.

Dr. Carl Lum, a retired surgeon and volunteer with Aloha Medical Mission, toured Aceh province in Indonesia for two weeks, providing medical care to tsunami survivors. He returned last week and has been preparing a team of doctors and nurses for another mission. Photo courtesy Dr. Carl Lum

It's difficult to say how far into the future the relief missions might extend, said the 78-year-old Lum, because the treatment of the initial injuries and illnesses is only the beginning.

"The worst is yet to come," he said. "The worst is malaria, cholera, typhoid ... there's no sanitation, no water to bathe. The big problem will be a month or so from now. The whole countryside is stagnant water, and mosquitoes are everywhere."

So are the dead bodies. Lum, accompanying a crew from the charity Food for the Hungry, disembarked Jan. 10 from an Australian cargo plane and toured Banda Aceh, where more than 94,000 died, more than 123,000 are missing, and about 400,000 were driven from their homes.

"You see miles and miles of destruction, everything is leveled, leveled to the ground," he said. "Even the vegetation is gone, with only a few palm trees that survived.

"The whole place is rubble, and under the rubble, bodies. Every day as we drive by, we see new bodies. When they clear the rubble, they find bodies and put it out on the side of the road for the military to put in the pit and bury."

Lum is one of the Hawai'i residents who have immersed themselves in the task of salvaging life from the instant graveyard produced when 50-foot waves swept through villages and cities around the rim of the Indian Ocean.

Leah Kern, a Punahou School and Harvard Medical School graduate now in her pediatric residency in Washington, D.C., just returned from Phang Nga province, where the worst of the destruction in Thailand occurred.

Kern accompanied Smile on Wings, a small charity that focuses on offering dental care to Thais. Most of their work centered on treating 5,000 refugees in a camp at Bang Muang, she said on the telephone. The school had survived and reopened, she said; there were latrines, bathing areas and even play tents for the mothers and children.

By contrast, Lum said, the obstacles to wresting a normal existence from the debris of Banda Aceh seem almost insurmountable. It may be 25 years before the city is cleared and truly resurrected, he said.

Lum had no use for his surgical gear, because there were no facilities suitable for that service. Instead, he spent his time delivering basic first aid to the refugees, inoculating patients against tetanus and measles.

Food for the Hungry brought filtration units to extract safe drinking water from the ponds, he said, but they still had not been set up when he left.

His advice to his colleagues is to bring no more than one suitcase into which they must fit as many medicines and supplies as possible, as well as extra food for themselves.

Beyond that, it's hard to predict what they might encounter: The mission expects to be airlifted into more remote coastal areas. At a moment's notice, a limited number of spaces might open up on outbound military helicopters, so the group is likely to be split up.

"I told them they have to be flexible," he said. "When you get there, things change every day."