Just a little at a time. That’s what Yasodha Natkunam keeps reminding herself one year after the massive Indian Ocean tsunami devastated her war-ravaged homeland.



Despite the renewed threat of civil war and the undelivered millions in aid, the Stanford University pathologist continues her crusade to bring 21st-century medical care to the isolated region of northern Sri Lanka, one person at a time.



She has brought a Sri Lankan student to Stanford - paying for his plane fare, putting him up at her Sunnyvale home - to teach him how to use the high-tech microscopes and other equipment that she delivered to the impoverished flatlands last spring during her first journey home in two decades.



With renewed political tension stalling Sri Lanka’s rebuilding efforts, Natkunam understands her project to upgrade the region’s rudimentary medical labs requires both urgency and patience.



“The effort will continue as planned, just a little at a time,” she said. “I am an eternal optimist.”



Her goal is to build the intellectual foundation for medical laboratories that can someday diagnose illnesses on the spot, saving lives.



The Mercury News accompanied Natkunam in March as she traveled combat-battered, one-lane roads to deliver five microscopes to primitive labs in the hot, insect-infested region of northern Sri Lanka. She negotiated past tense political checkpoints, assuring both sides in the country’s decades-long conflict that the sensitive equipment was intended for peaceful purposes.



Stanford and Scientific Instruments of Sunnyvale had donated the used microscopes, which cost about $25,000 apiece when new.



The microscopes have since been used to screen blood smears, identify malaria parasites and train students in Sri Lanka’s Tamil region.



But without pathologists and specially trained technicians, the microscopes are not being used to diagnose cancer, as Natkunam hoped. Instead, patients often don’t learn about their disease, are diagnosed too late or must travel hundreds of miles to the capital city of Colombo for treatment.



That’s becoming increasingly difficult. Escalating violence in recent months threatens a delicate cease-fire, and the government has declared a state of emergency that authorizes detentions and searches without warrants.



Promised aid money has been slow to trickle into the region, adding to Sri Lanka’s post-tsunami economic woes. Many still live in temporary shelters - single rooms with concrete floors, wooden walls and thatch roofs.



So Natkunam turned her attention to training Sri Lankan technicians here in the United States.



“Teaching a skill -- that’s something that can be passed onto others, and lead to good things,” said Natkunam, 40. “It is one way to make a difference.”



Her first student recently returned to Sri Lanka after spending months observing Stanford technicians prepare and diagnose diseased tissue specimens. The student, Suresh Kumar, a 35-year-old Tamil Sri Lankan, works at the government-run Jaffna General Hospital.



“Stanford made it possible to show him how a clinical lab works,” Natkunam said.



She hopes to bring another student to Stanford when she has enough money. Even that has been tough, though, because it is unsafe for potential students to travel and Sri Lanka’s political instability has complicated fundraising.



“I just do what I can do,” Natkunam said.



On the morning of Dec. 26, 2004, Natkunam was at home in Sunnyvale, watching television while making breakfast for her children, when she learned about the giant waves.



It had been 21 years since she last saw Sri Lanka. She left as a student, with an imminent civil war threatening her dream of practicing medicine. Her parents were successful government physicians, even though they are members of the Tamil ethnic minority.



In 1983 tensions with the Sinhalese majority were worsening. Eight classmates in Natkunam’s college class were missing or imprisoned. Many others had already fled.



The dream of returning to her homeland to rebuild a medical system had been playing in her mind for years. The tsunami, which killed about 35,000 Sri Lankans, was her push.



“When I saw the footage, I realized I was overdue to go back and start working to help,” she recalls.



Even before the tsunami, an economic embargo had blocked food, fuel and medicine in the northern Tamil region for years. Microscopes were basic, where they existed at all.



Natkunam knows Sri Lanka’s brightest hope lies in its 1 million exiles - like Natkunam and her parents - who had the wherewithal to escape years before. Now, she fears more fighting and more death could further complicate her plans.



Yet she yearns to bring more equipment to the region - and bring more students to Stanford, seeking donations for their plane tickets.



“There is a lot to do and there have been major setbacks,” she said, “but I’m very hopeful that we will make progress.”