From: McDaniel, William J ADM
Sent: Tuesday, April 19, 2005 10:15 PM
To: Subject: Sitrep Nias Island 19 April
You have received the numbers from yesterday via Mercy sitrep from the Captain, so I will not go over them much. 13 admissions did stress the staff, however, along with the 13 discharges. Especially in ICU, where the level of intensity continues unabated. Lots and lots of man hours spent there by our ICU staff, most of whom we lose on Friday when Project Hope personnel disembark. 11 surgeries yesterday, and again dental and optometry saw many patients ashore.
There were several interesting encounters ashore yesterday. A 34 year old Indonesian woman came walking up to our comms center with one of the most unusual clinical conditions I have ever seen. 19 years ago she sustained a broken left tibia (shin bone). Two metal plates were wired to the bone at that time as splints, I suppose. Soon the skin and tissues overlying the bone and the plates became infected and the plates and bone were exposed to the air, in a hole in the front of her leg about 3 inches by 2 inches. The bone healed, however, and she had been walking around with this infected wound for 19 years! With metal plates, wires, and bone clearly visible. How in the world she managed to do this is beyond me. When we asked her what bothered her most, she said, “The smell.” We looked at her leg and told her we thought we could help her, getting rid of the plates and wire, getting rid of the infection, and covering the bone. As our interpreter explained to her that she would have to go to the ship by helicopter, but everything would be free, etc., she started crying. The helo ride does scare some folks, and some have backed out because of it. We asked why she was crying? “Because no one has ever offered to help me before.” This sort of brings it back to the reason we are here. Because we can offer to help.
One of our comrel teams was at a school painting and repairing the library. As they began work in the morning, RP2 Bryant, working on the team, noted that the classroom next to the library had no teacher. He found out that the teacher had run off to the mountains after the earthquake on Saturday, and he had not returned to the room of 12-14 year old kids. Bryant stepped into the classroom and took over. Using his Indonesian phrase book, he started teaching the class the English translations. He was writing on the blackboard, the kids were excitedly reciting every thing out loud, and he had them singing the “A,B,C” song. They loved it! He spent the entire day teaching, and would occasionally sit at the desk, pound it with his fist, and shout, “Dunia!” (“The World!”) The kids would all shout it back in return. I have no idea why he did that, but apparently they did. There was an interested crowd of about 50 envious school kids of other ages watching through the windows as he taught. It was truly amazing, and probably those kids will never forget this impromptu substitute teacher. However, they never did catch on to the concept of “Old McDonald Had a Farm.”
We had only 3 admissions today, and 6 discharges; with the intensity level of the patients in the hospital, and with the pending departure of the majority of our nursing staff in 3 days, we had to slow things down a bit. We did 11 surgeries again, however, including the surgery on the young woman noted above. (I scrubbed in and tried to stay out of the way, and I think her wound will heal and the bone will no longer be exposed. The metal plates, 19 years later, looked brand new. Darned good metal.) On shore we saw 10 consults, optometry saw 206 patients and handed out 194 pairs of glasses, and dental, under the leadership of “Quick Hands” CDR Kurt Hummeldorf, saw 98 patients and pulled a total of 251 teeth. Kurt was so tired tonight he had trouble lifting his arms. An interesting vignette occurred in the endless optometry line. A fellow who had been waiting for a few hours to get his turn with the optometrist passed out and had a seizure. Our staff took care of him and attempted to call an ambulance. However, he came to and realized that if he went to the hospital, he would lose his place in line. He refused further care until he got to have his eyes checked. These folks do like their new eye glasses.
Drs Polifka and Garrett handled consults today, and gently started turning down patients whose care is going to take longer than we are going to be here, and whose intensity of care is going to be too high. Thus begins our exit strategy, discussed at length and initiated today. One of the major problems here is going to be the lack of physician medical staff when we leave. There are a number of other volunteer physicians in the hospital, but most will be gone by the time we leave. The hospital is currently staffed with only a couple of general practice doctors. They will have a difficult time. One of the saving graces, however, is that there is a nursing school here, and the nurses wind up staffing the hospital and doing most of the medical work. We are intensifying our efforts to educate the nurses through CDR Suzanne Clark’s efforts.
The comrel team got lots of painting done today, and volunteers from the San Jose and Niagra Falls vied to see who could get the most done; they both did great. 30 volunteers worked hard all day, and will continue to work on the nursing school for some time to come.
Preventive medicine and Public Health did 2 major projects today.
First was extensive air sampling, then going into the hospital and instructing the hospital staff on the use of nebulizers and bronchodilators. They have been treating asthma patients with cough syrup, and now have a basis for correct treatment of these patients, who will likely be happy for the effort.
A team went to Lololofuti village today to do structural analyses of the buildings and see if they sustained much damage from the earthquake. They were met at the landing zone by 942 villagers, the entire population. Then, all adjourned to the village elder’s home, where that gentlemen noted that our team was the first Westerners in the history of that village to have ever visited there. In fact, immediately after the earthquake the chief had his folks construct their first helicopter landing site, assuming that perhaps there would be teams coming out to check up on things. Today, he was a proud man. His preparations had not been in vain. Once the team had checked out all of the buildings (all were OK), he gathered them together and apologized. Their tradition is to ‘share bacon’ with distinguished visitors, but they had not had time to kill a pig and cook it. So, he gave them a live pig. They had a problem; a refusal without good reason would insult him. (There admittedly was strong consideration to accepting the pig and returning to Mercy with it just to see what would happen next.) However, they explained to the chief that pigs generally were not allowed on helicopters, and they had to regretfully refuse the gift. They were allowed to leave only after signing a pledge that upon their return someday they would stay long enough to ‘share bacon.’
CDR Clark, as noted, taught a class of 55 students today how to start IV’s; there was great enthusiasm from the nurses for the project.
Our humanitarian team, including our JAG lawyer, continued to work today at getting two kids needing complex surgery back to the States for care. They met with both the Bupati (sort of a super mayor) and the governor of Sumatra, both of whom strongly support their efforts. They are working closely with the US Embassy as well.
Finally, our helos and rib boats continue to do absolutely outstanding work, and all personnel were ashore by 0730 this morning. As has been their standard, CAPT Leahy and his crew are supplying the strongest possible support for our efforts here, and are full members of this team in every way.
Today we returned a 41 year old man to his home where he can die while with his 7 children and his wife. He was crushed in the earthquake, and is paralyzed from the mid-chest down. We have been working with him for 2 weeks now, but he just has too many problems, and we cannot save him. We took him and his 17 year old son back to Gunungsitoli Hospital yesterday. Several of us spent most of the day trying to find someone to return him to his village in the mountains about 40 km away. There were no takers. The UN helos are down, and for ambulances it is an all day trip. So, we considered the mission on Mercy and felt that we owed him and his family our best shot at it. Today we placed him in a helo, and the HC-5 pilots went looking for the coordinates. At the site the ‘landing zone’ was covered with tents. They flew around the village looking, and landed in the middle of the very large playground of the local school. (No children were visible.) This was probably the biggest event in the school’s history, and classes immediately let out and the children stood on the verandas cheering and waving, closely monitored by their equally cheering teachers. We carried our patient with great care to a local house, where he was to remain while his son walked the 2 km to get some family to help carry his father home. When I returned to the ship tonight I was asked many questions by lots of staff about him, all anxious to hear that we had been successful an reuniting him with his family.
I’ve noted it before, but it still somewhat stuns us at how appreciative and delightful these people are. It is truly a pleasure to work with them, and for them.
From: McDaniel, William J ADM
Sent: Wednesday, April 20, 2005 10:44 PM
To: Subject: Sitrep Nias Island 20 April
Winding down. We start as hard as we can, build up quickly, then immediately start calculating and trying to make sure we get every patient off Mercy before we have to leave. There is nothing constant about this; always changing, adapting to events like suddenly moving Mercy to Sibolga to off-load those of us going home on Friday. We have contacted most everyone and everyone understands that we have a finite amount of time to spend here, and the end is rapidly approaching. The only ones who do not understand are the patients, who see us as the only decent medical care most of them have a chance of ever receiving. However, while I am sure they do not understand the timing of or reason for our departure, they accept it with a smile, or with sadness—but still with a smile—and go on about their life. They appreciate anything we can do for them. As the young lady with the tibia plates exposed told us, “No one has ever offered to help me before.”
I did not go ashore today, but instead spent the day making leisurely rounds and watching the patients. We could still be off Banda Aceh; there is still the support and friendship between all the patients and family members, the easy way of relating to each other and to us, the laughter on Ward 1, where most of the children are. Our little 18 month old girl with the heart defect is certainly one of the most beautiful children I have ever seen, and charms everyone by smiling, laughing, clapping her hands, and delighting in being the center of attention. It does look like we will be able to complete the tedious process of getting her and the 7 year old back to the States for care.
I talked for a long while with a 26 year old interpreter, Ayu, who was also with us in Banda Aceh. She wanted to know which I liked better, Aceh or Nias. Not about to fall into that trap, I praised them both. She laughs easily and is very fluent in English. I asked her about her family. Her Mother, two cousins, and Ayu hopped in their car and tried to outrun the tsunami. Everyone else drowned when the car was inundated. She managed to swim out through a window, and remembers seeing her older brother running carrying her 4 month old cousin. She saw the tsunami catch up to them, and for a moment could see only his arm holding the baby above the water; then it disappeared. She saw the baby and arm one more time, then both went down again. She managed to grab on to a building and saved herself. That night she was going from building to building…and found her brother and 4 month old cousin, miraculously alive. I realize this is old news, but listening to Ayu softly tell it, it will never be old news to her.
Benny, the little baby I held on to and talked to several days ago for a couple of hours while waiting for the helo to arrive, is surviving well. His seizures are controlled, but no one will know for some time if he will have normal mental function. Holding him brought back a flood of memories; I noted that he did squint a little when I was talking with him. I expect he got tired enough of hearing me the last time I talked with him for so long. The young lady whose leg we operated on yesterday is doing well. And, the surgeons did a major surgery yesterday, taking out part of a diseased lung from a young woman, totally changing—and extending considerably—her life. She looks super today. Finally, the 15 year old girl we did emergency surgery on a couple of days ago after she was hit by a bus is looking outstanding, and will be extubated (tube removed from her trachea) soon.
We did 9 surgeries today. We sent 72 people ashore. 10 consults were seen, and optometry saw 172 people and gave out 155 pairs of glasses. Dental saw 45 patients, but upped their average per mouth by taking out 204 teeth. One patient skewed the average, however, by contributing 26 teeth to that total. As has been noted before, none of these patients has ever seen a dentist before—and that one probably won’t again. Today was an extremely hot day ashore, and even the locals were seeking shade and shaking their heads.
3 ER doctors from Project Hope went in, Dr. Polifka, Dr. Garrett, and Dr. John Neal, who will be taking over their duties after tomorrow, as he is staying on. They noted that they are seeing very few earthquake related injuries at this time, but lots of major tumors and other chronic problems as people become aware that we are here. Unfortunately, these are all too long term to attempt to treat now. Luckily, 4 or 5 new Indonesian volunteer physicians have shown up to work at Gunung Sitoli Hospital; they were badly needed. We are screening now for those cases we can get in and out within a few days, and which have a low grade of acuity, requiring much less nursing care.
The comrel folks under Chaplain Owen had a good day again. They finished painting much of the nursing school, plus patching some floors. They did lots of painting and repairs to the boarding school, and repaired a roof and eaves so that the leaks are now stopped. The installed lighting in one room. A total of 31 folks from 3 ships were in these working parties.
CDR Suzanne Clark continues to upgrade the quality of medical care by teaching the 57 nursing students. Today they learned all about wound care and sepsis. She noted that the hospital has had a ventilator donated, but no one knows how it works. One of our anesthesiologists will go in tomorrow and examine it and teach them how to use it.
The environmental health folks went to the NGO Oxfam and worked with them today. They found an obscure water system serving about 500 people and sampled it for quality, plus taking a number of air samples.
2 preventive medicine and Public Health teams flew to outlying areas. Lowala is a village of 2000 people where they looked at the clinic, churches, and schools, for a total of 19 buildings examined. One of the school buildings, with a total of 300 students, is unsafe. They will get IOM to donate enough tentage to move the kids out of that building.
The other team went to Madrahay village, where another 37 buildings were inspected, including 4 churches, schools, puskesmas, etc. Water samples were taken from the local water supply source, and the local nurse was given training. They donated some medications to the clinic.
Unfortunately, no ‘bacon sharing’ was offered today.
In our humanitarian mission to get the two children to the States for surgery, LT. Molldren, the JAG lawyer, spent quite a bit of time ashore with Dr. Van Nimweg and CDR Bangs visiting with the Governor and the Bupati. We should have all paper work completed to get the passports and visas tomorrow. Again, CDR Bangs is absolutely invaluable in this effort as he knows the politics of the situation, who to talk to, how to talk to them, and speaks the language. This would be almost impossible without his efforts.
Tomorrow will be a light day as we have a re-supply going on. Friday is a national Indonesian holiday, so we will send in only 30 people as the ship transits to Sibolga and back. Tonight the MSC crew had an ice cream social on the fantail for the Project Hope personnel. (Inasmuch as I needed to report on this event, I attended and had some MSC ice cream as well.) The ship’s Master, CAPT Leahy, offered deeply felt thanks to the Project Hope personnel for their part in this last several months’ evolution. He noted that this was a most unique undertaking, which it certainly is. No one who has been here will ever forget it, and most of us have grown considerably in our appreciation for our fellow inhabitants of this earth because of being part of these events.