Claire Rieux, MD, in Indonesia

Idawati's Story: Surviving the Tsunami in Aceh

Claire Rieux, MD, is a Doctors Without Borders/Médecins Sans Frontières (MSF) volunteer working in Sigli Hospital in Indonesia's Aceh province. Most of the Indonesian medical staff members in Sigli Hospital were killed by the tsunami. First MSF dispatched a surgical team to provide surgical care for people suffering from infected wounds. The MSF team was later replaced by a group of Indonesian surgeons. Now MSF is providing general medical support to the hospital. The following is a diary of Dr. Rieux's work at Sigli Hospital.

People are starting to return to the areas that were destroyed. In these places at the end of the world, rubble and debris are strewn next to a book, a mattress, or a chunk of wall with a mirror still hanging from it. – Claire Rieux

January 23, 2005- Day 21 after the Tsunami -Sigli Hospital

Very, very intense emotions today. One of our patients has contracted tetanus and is not doing well at all. He has difficulties breathing. We do not have the mechanical ventilator needed for him to breathe. Gathered at his bedside, we are debating the best options for the patient. "We" are the Sigli team: doctors, surgeons, anesthesiologists, nurses from Surabaya, the local hospital, and MSF. The day before yesterday, another MSF surgeon called to inform me that a German hospital ship, navigating along the coast of Banda Aceh, was equipped with an intensive care/ resuscitation unit. It's the only place in the region where a patient can be mechanically ventilated. I contacted them and explained the situation. They will pick up the patient using a helicopter. Francois, logistician and a great organizer, found the best place for the helicopter to land: the stadium. Meanwhile, we decided to perform a tracheostomy (an incision above the Adam's apple into the trachea to facilitate breathing). We inflated the patient's lungs with an "Ambu" bag, ventilating manually, and all of us taking turns.

The patient's wife-ever-present and so caring since the beginning of her husband's ordeal-is now confused and undecided. She sees her husband lying unconscious, a hole in the trachea and we are telling her that we are going to transport him to a German ship near Banda Aceh in a helicopter. She doesn't have the courage to accompany him and it's the patient's brother who will. It's 11 a.m., the German team is expected at 2:30 p.m. The waiting begins. Silence in the intensive care unit as time seems to have stopped for everyone. All ears are tensed, attentive to the slightest sound of a helicopter's engine in the distance. Suddenly, they are here: three men equipped with high-tech medical gear. After a quick discussion, the patient is transferred to the hospital's ambulance, driven by a surgeon from the emergency unit. At the stadium, a crowd has gathered-curious-around the massive helicopter. The stretcher is carried into the helicopter, doors close, everybody steps away, and the "bird" takes off in a gale of dust.

January 21, 2005 - Day 20 Post-Tsunami - Sigli Hospital

The imam chanted all night long - it's the AÏd holiday. Our Indonesian team woke up early to pray and tonight we will all have a good dinner together. Internationals and Indonesians, we have all come here with the same intention - to help the tsunami victims. Yudi, a young OB-GYN, was working in Banda Aceh. His hospital, an imposing white building, still dominates the landscape at the coast but the damage is so extensive that major repairs will be necessary before it can resume functioning. Some of his colleagues, particularly the head of his department and the man's family, are dead. He wanted to help his country and came to find us.

The story is the same with Usman, a surgeon and professor at the Bandung medical school on the island of Java, and Edriania, a private nurse who was caring for a single wealthy patient. She cried so much watching television that she asked her employer for leave to come here. Avi is a banker in Jakarta. He's working with us as a translator and helps us manage in all sorts of situations. Joyo, Katija, Yunis, Yusuf and Tiur are nurses. Nasar and Tina are the lead doctors on the mobile clinics (specialized consultations in the camps and villages). At the hospital, we are working with a medical-surgical team from Surabaya University. They have some experience with natural disasters. We are sharing our knowledge and the way we do things. It's good to feel that sense of solidarity in the field every day.

January 20, 2005 - Day 19 Post-Tsunami

Today we went out to conduct an anti- measles vaccination campaign. We don't have any reported cases right now, but the displaced persons are living in close conditions that can promote the spread of the disease. After an hour's drive through rice fields, we stopped at the first camp. About 100 families are living in tents placed around the mosque. We set up our equipment while one of the camp managers used a megaphone to alert people that we had arrived. Children lined up to follow the whole circuit: registration, confirmation of their nutrition status, vitamin A, vaccination, and vaccination card. Some were very calm about the process but others screamed when they saw us approach, which made everyone else laugh. These people have lost everything and they're still laughing. What a lesson. In some camps, living conditions remain precarious. More than 50 people are sharing a single tent. They are sleeping on mats on the ground, which is often muddy because of the daily rains. Access to water and availability of latrines remains a problem. However, it is not easy to plan for sanitation in these camps because they are temporary and constantly shifting. One of the options is to distribute water daily, along with family tents, plastic sheeting, water containers, mosquito nets, and soap. At least that will make it possible for people to hold on for a while under better conditions, hoping that this situation will be resolved as soon as possible and that people will be able to rebuild their houses quickly and go back to work.

January 19, 2005

People are starting to return to the areas that were destroyed. In these places at the end of the world, rubble and debris are strewn next to a book, a mattress, or a chunk of wall with a mirror still hanging from it. We meet a father who clutches a small piece of green fabric. He tells us that it is from his son's pants. The waves carried off his 5-year-old. Some people are sitting in front of what remains of their house or boat, a cigarette dangling from their lips. Their gaze is a bit empty. But many have come looking for anything they might be able to use to rebuild: planks of wood, bricks, or rebar. Bare-handed and wearing flip-flops, they rummage through the piles, risking injury and tetanus. There are several tetanus cases in Aceh province right now. We currently have six tetanus patients at the Sigli hospital and have developed a specific treatment plan for them. Several of them are in a semi-coma and require intensive care, often for more than two weeks. They were injured during the tsunami and could not be treated properly or quickly enough, particularly with respect to vaccinations and injections of anti-tetanus immunoglobulin. We don't want any more new cases. That's why we have begun systematic prevention efforts for all patients who come in with injuries. We also have to consider the possibility of an information campaign in cooperation with local authorities in an effort to halt this pathology.

January 16, 2005 - Sigli Hospital

Idawati, 22, is leaving the intensive care unit, where she spent more than a week in critical condition. She arrived at the hospital with a deep groin wound and a pulmonary infection from inhaling seawater. She underwent emergency surgery but the infection had already spread and she developed septicemia. Virginie, a nurse specializing in intensive care, and I stayed with Idawati well into the night to care for her and monitor her condition. With our eyes glued to the equipment that allowed us to keep close track of her blood pressure, pulse, and breathing patterns, we adjusted our treatments. Little by little, her condition improved and thanks to those efforts, combined with the work of the Indonesian team, she is out of danger.

She is now smiling and doing much better, so today I finally asked her what had happened. When the tsunami struck, the future teacher was in Banda Aceh, in the house she shared with some other students. She was doing the laundry. All of a sudden, she heard people yelling. She managed to run about 150 feet before the wave caught her. The next thing she remembers is that some friends came for her and brought her to Sigli, two hours away, because the Banda Aceh hospitals still standing were overflowing with people. Her school was destroyed and she does not know what happened to some of her friends there. Fortunately, her family members are safe and she has somewhere to go when she leaves the hospital. That is not the case for many others, like Zafrizal, one of 30 survivors from his village of 900 inhabitants. After receiving emergency medical care, the next issue will be to help survivors rebuild psychologically and materially, in terms of housing and tools, so that life can go on.