INTRODUCTION: On December 26, 2004, a 9.0 magnitude earthquake centered 155 miles off the coast of northern Sumatra, Indonesia, generated a tsunami wave that killed more than 283,100 people in Indonesia, Sri Lanka, India, Thailand, and other Indian Ocean costal nations. Though perhaps not intuitively obvious, the general surgery resident possesses a specific blend of medical knowledge and procedural skills uniquely suited to provide medical relief under such circumstances. METHODS: A 12-person team of volunteers provided medical care to a rural Aceh population of an estimated 6,000 people for a period of 6 days 3 weeks following the disaster. The team was comprised of 4 nurses, 4 translators, 1 public health worker, 1 security/communications officer, 1 infectious disease physician, and 1 general surgery resident. The team conducted well-child, maternity health, and acute care clinics, in addition to serving the emergency medicine needs of the population whose own healthcare infrastructure had been destroyed. RESULTS: The team treated 311 patients from four primary villages. 163 patients (52%) were female, and 137 patients (44%) were age five & under. 144 patients (47%) had lost their homes and 54 patients (17%) had lost one or more 1st-degree relatives as a result of the tsunami. 55% of children seen were under the 30th percentile in weight for age, and 20% were under the 5th percentile. The 10 most common diagnoses among the patients treated were Well Child (69), URI (56), Viral Syndrome (18), Impetigo (14), Musculoskeletal Pain (13), Headache (12), Helminthic Infection (12), Pregnancy (11), Dyspepsia (9), and Fever of Unknown Origin (9). An additional 7 patients required minor surgical interventions for incision & drainage of abscesses, wound debridement, or repair of skin lacerations. CONCLUSIONS: Medical relief work following a natural disaster is challenging because numerous factors affect the health of the surviving population. In this case, the remnant of the physical trauma inflicted by the tsunami itself was superimposed on a background of endemic tropical infectious disease, poor nutrition, poor hygiene, and poor health education. The result is a displaced population of people with limited physiologic reserve who require a combination of care for old infected wounds, new wounds, new infections, post-traumatic mental illness, and ongoing health maintenance. General surgery residents are chronologically close to their primary medical education, possess the procedural ability to manage infected wounds and skin lacerations, and are generally resourceful individuals who can manage such issues under austere conditions.