It is 14 April, and I have been back in the area for the last 12 days or so now. As you might imagine, I was surprised to be returning quite this quickly.
I spend most of my time ashore on Nias Island, sleeping in a tent and working with many others on establishing a good patient referral process to Mercy. With absent to limited communications, and many portions of the island inaccessible by other than foot (due to road disruption), there is no simple way to get patients out of the hills. Helos can only do so much, and just as we were starting this 7 of our Australian friends we had worked with died when their helo crashed and burned at one of the sites, Afulu. Being on shore is…very warm. 108 today, but it somehow feels a whole lot hotter than that. We go around with shirts dripping wet, the locals go around with several layers of clothes on, as if it were a cool day. Maybe they just practice good psychology. I am not going to try it, however; my powers of self-delusion are not that good. In addition to being hot, the ground is unstable. We feel earthquakes daily, and the 6.2 that hit a neighboring island a couple of days ago had us quite happy we were sitting under an awning out of range of any tall falling structures. The island has actually raised up about 6-7 feet, and there is lots more beach exposed now than they have ever had. I continue to worry about Newton and that apple, however. There are few things that go up that do not eventually return to where they were. I’m afraid this may be no exception. There are about 30,000 homes and businesses destroyed here. 8.7 is a big earthquake. Most of those flattened are concrete or brick, and include 80% of the churches in this Christian part of Indonesia. Homes and businesses made of wood, apparently not very substantial, seem to have survived the quake quite handily. About 1000 people died, and no one knows how many were injured. We are still trying to find them. Of 600 villages on Nias, only 200 have been surveyed for medical problems. You just can’t get there from here.
Today we have 50 patients on Mercy (our capacity), plus relatives accompanying each of them. 8 in the Intensive Care Unit, with 2 very sick pediatric patients there. Several in isolation for tuberculosis. 23 surgeries yesterday and today. 119 X-rays taken as of this morning, as well as almost 400 lab studies conducted. 9 admissions today, 12 yesterday. At least half the surgeries are extremely complex, difficult cases. I just stopped one of the orthopedic surgeons in the hall, who has not rested much since arriving on board on Sunday. He said this work is extremely gratifying, and he is thrilled and honored to be here doing it. He also said these were some of the most difficult trauma cases he has ever been involved in. We are truly at maximum capacity at this time. The only way to get busier would be to add more personnel, open more than the two wards and one ICU, and add another operating room or two to the mix. I think we will maintain this pace for a while.
I spent quite a bit of time down on Ward 1 tonight. Amazing. Kids running and playing, even the ones with severe burn and tumor deformities. Babies were everywhere, and over to one side was an 8 day old baby with its Mom and Dad. Mom had a ruptured bladder in the delivery of her baby, so the whole family is together as she recuperates from some super reconstructive surgery. The child is resting in a most wonderful crib built by the engineers on Mercy. This thing would sell great at any outlet in the States! I hope they patented their crib work. I visited with a 13 year old girl whose parents and brothers and sisters were killed when their house fell in on them. She is here with her uncle and grandfather…the latter having 3 broken extremities. A woman whose leg we amputated yesterday for severe infection of the bone smiled and gently grasped my hand for a moment, saying nothing. That was enough. A little 17 month old girl with a serious heart defect was sleeping peacefully, awaiting word on whether we will be able to bring her to the States for a curative surgery. She was beautiful. In the corner I sat a moment with a very sad woman with broken legs; I found out that when her house collapsed in the earthquake 2 weeks ago her baby was killed. We will fix her legs, but can’t fix her heart.
As was the case in Banda Aceh, these people do not desire isolation or privacy. They bond together and support each other, and the entire ward is a family, sharing happiness and commiserating in sadness. There are no loners here; the others are always there for them. As I left the ward, I saw a 7 year old boy asleep on his bunk, and his father lying on a mattress on the floor beside him, arm up on the bunk holding his son’s hand as they slept. That is the way with these wonderful people.
The pictures I have sent along with this were taken by one of our photographers. I was unaware he was in the area, but am glad he was around. I was coming back to the ship after having spent a couple of days in the tent; cleanliness is not necessary, I suppose, but sure feels nice. I heard we had a ‘stable’ 13 month old boy with pneumonia who needed to be taken to the ship, and volunteered to take him, with Dad coming along. On the ride from the (very, very basic) hospital to the soccer field where our helos land, I noted that the child was not quite stable. He was burning up and struggling with every breath for enough air to go on to the next breath. We got to the field and I immediately started bathing the child with water, having borrowed a towel from our driver. Dad anxiously stood by to keep the towel wet for me. I was imploring the dispatcher to get a helo on the ground NOW! Unfortunately, the ship was 80 miles away picking up some arriving personnel, and the helos could not get to me for almost 2 hours. I talked and talked to this child, begging him not to die. Dad started crying well after these photos were taken, squatting down and holding his face in his hands, looking up only when I needed more water on the towel. A crowd gathered; they always do here. A couple of local photographers were taking pictures, and I was feeling as helpless as one can feel. I had nothing to offer but words and a damp towel. Finally, the helo came swooping down in a hot approach, bounced once, and we were in it and airborne. Another doctor came up just as the helo arrived, and he and I worked on this child for the next 30 minutes as the pilots red-lined the chopper at about 200 feet above the ocean. They knew a life was hanging in the balance, and seconds most definitely were counting. The child repeatedly stopped breathing; he was just too exhausted from trying so hard. We did everything we could to keep his airway open and him stimulated to take just one more breath, then one more after that. Finally, though, we were on deck and the wonderful pediatricians took him and did their thing. I do not recall being that tired, ever. I stood, absolutely emotionally and physically spent, watching them intubate the child and get IV’s running. CDR Comlish and CDR McDonald, outstanding and understanding nurses, came over and tried to get me to sit down before I fell down. I was bonded to that kid, and just had to watch for a while. They asked me what happened, and I found that I could not talk at that time. If I kept my mouth shut, I would not cry.
Due to some outstanding pediatric and nursing care, that little boy is still alive and laughing at his Dad.
So, we are again engaged with these people of Indonesia, and again this is impacting us all. Not like Banda Aceh; that was so immense it was incomprehensible. Banda Aceh just stunned your soul into numbness. This is bad, but can be comprehended. However, for those patients here whom we are saving, this is the worst thing that has ever happened, that can ever happen.
I expect (as Shirley laughs) to be leaving here within a week or so. My job of helping organize relations ashore is largely done, and the only other thing I do is chronicle these events. It is truly time to play some golf.