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After the tsunami

Thu, 17 Feb 2005

After the tsunami

By Judith Martin

The stench and the sight of thousands of long-dead bodies in mass graves, was not something Private Stephen Van Deursen expected to experience so early in his Army career.

The 20-year-old soldier, from Newlands in Wellington, is solemn as he describes seeing the lineup of long black trucks waiting to disgorge the Achenese victims of the Boxing Day tsunami and earthquake into a huge roadside grave.

"It brought home the reality of tsunami I suppose. You can see it on TV, but until you get here...."

PrivateVan Deursen is one of the 30- strong NZDF team in Banda Aceh, the area worst hit by the tsunami, helping get the devastated area back on its feet. The disposal of bodies is not his domain - that's left to the TNI (Indonesian military) - but the trucks and graves were unavoidable when he first arrived in Aceh. "I felt a bit overwhelmed at first, but then you just get on with it. It's good having mates here to talk to."

As he pitches in to help the rest of his team with its main task of providing medical care to the sick and injured, he concentrates on the task at hand- helping the Kiwi medical team wherever he is needed - and is soon smiling and joking with the TNI soldiers he is working alongside.

The NZDF team, made up of doctors, nurses, medics, and support staff such as communicators, drivers, and general duty soldiers, is weary.

As contingent commander Major Charmaine Pene wipes sweat from her neck and puts her feet up for a five minute break, she looks around the still muddy but now bustling Anzac Hospital her team helped establish with their Australian counterparts, and recalls how, when she first arrived in Aceh, she wondered how the task ahead of her could be achieved.

Pitching hootchies (makeshift tents) in the dark and rain in a sewage splattered patch of grass at a chaotic airport on the first night they arrived was nothing compared to what awaited them at the local hospital where they were to begin work.

The first five days, Major Pene recalls, were spent scraping and scrubbing layers of sewage-contaminated mud, which coated nearly every surface throughout the wards. With little water and makeshift cleaning gear, the team, including its doctors and nurses, donned gloves and gumboots and began the long and grimy task. Their wards are shared with Australian medical teams, with one treating infectious diseases, and another providing resuscitation, x-rays, operations and surgical care.

"We still had a few hours of cleaning to do, and they (patients) just started coming in - we couldn't turn them away - but we coped. It was a matter of having to," says Major Pene. The team has been working 12-hours shifts, after which they enjoy a two-minute communal shower before dining on an Army ration pack. A fresh evening meal is delivered about once a week.

Sitting down to join her for breather after a morning spent treating patients in her infectious diseases ward, Captain Charmaine Tate, one of the team's two doctors, explains how the medical team's focus has changed and developed since it arrived.

"At first we were dealing with really bad trauma as a result of the tsunami. Dozens of people were presenting with severely infected wounds, and conditions such as aspiration pneumonia where they had inhaled the bug -ridden tsunami water, and tetanus. The tetanus vaccination programme here is relatively new, so only the kids have been vaccinated. Tetanus is not a condition we see in New Zealand. We had to learn fast the best way to cope with these patients. Many doctors had input, and a good formula was eventually found that enabled many of these patients top recover well."

The medical team brought a variety of antibiotics with it, and after consulting and sharing with the German, Singaporean, Australian and Belgium teams which eventually established clinics at the hospital, was able to successfully treat many of the very unwell patients.

"The sharing of information here is very useful," she says. "The other teams have specialists we don't, such as dermatologists and various surgeons. We can get a lot of input to help treat our patients the best way possible."

A veteran of medical missions to East Timor and Afghanistan, Captain Tate, 30, admits she, too, has had her darker moments since arriving amidst the devastation.

"When I first got here I thought, 'what on earth can we do?' There were about 200,000 people dead in this area, and so many critically ill people. You'd try to treat them but then they'd sometimes die anyway, they were so badly injured and without medical care for too long. I considered it was kind of like climbing a mountain. You break it down into the next two metres or so, and help the person in front of you as much as you can, then move on to the next one. And you get your really high moments, like the baby we delivered a few nights ago that came out flat and not breathing, but ended up kicking, crying and happy. And the patients who smile and laugh with you when they're on the road to recovery.

"We have to bear in mind that we have to eventually step out and hand all this back to the Indonesians. We're trying to get their doctors and nurses back in here, and teach them any new stuff they may need to know. You shouldn't come into an area, provide a capability, then leave and take that capability away with you. You have to set things up so they'll be on going. It's important to remember you're providing relief, but you're also providing a pathway for the local system to get up and running.

"It must be difficult to return to work in the hospital when your home has been destroyed and your family killed or missing, and I guess that's our job to fill the gap. These are resourceful and resilient people. I believe they have the will to overcome this."

In the resuscitation area behind the women, New Zealand Army doctor Major Paul Nealis, nurse Captain Rose Fraser and medic Corporal Lisa Pomana are tending a teenage boy who has had his arm ripped out in a silo accident. His distraught parents have brought the arm, still intact and unscratched apart from where it was ripped from their son's body, into the clinic. It cannot be saved, but the boy's life can. After administering drugs and stemming the blood flow, the boy is wheeled into the operating theatre where his wound is be treated by a couple of Australian Army surgeons.

"Imagine surviving the earthquake and the tsunami and then have this happen. The poor kid. His prognosis is good though, " says Captain Fraser as she helps lift the boy onto a trolley.

Charmaine Pene is obviously proud of the work her team, although now tired and ready to greet their replacements, has done.

"We came here as a primary health care team, but on the way the picture changed. We thought we could be going out and about, but our focus was directed towards the surgical wards which was most appropriate for this environment."

She, too, has served in many other medical missions, including East Timor, the Sinai, and throughout the Pacific Islands. Despite her experience, she says that Operation Sumatra, as the team's relief effort is known, has been the most arduous - but also rewarding - in her career.

"Sure the conditions have been tough, but our training lets us cope with that. All the soil that is being tramped around here is 90 percent fecal contaminated, and I've got to admit I was worried for my peoples' safety. But they're a self-disciplined bunch - they know to look after themselves. This Anzac hospital was the first medical organisation here with a full range of services. We've given the people of Banda Aceh their hospital back, and although we've lost a few, we've saved many lives. I think this team can feel good about what it has achieved."

New Zealand army nurse Captain Georgina Parata-Turvey's mother never wanted her daughter to work in a war zone. "My brothers -yes. Me - no. But I did it anyway," says the Linton-based nurse who has served in East Timor, the Solomon Islands and in Papua New Guinea after a tsunami there several years ago. She returned to New Zealand from a mission in Afghanistan a couple of weeks before Christmas. One thing her mother did instill in her though was resourcefulness, and that has proved indispensable in her nursing career, says Captain Parata-Turvey. "She taught me how to get by, which I've got to admit has come in handy here."

She led the establishment of the surgical ward, which was originally an eight-bed facility, but soon became a 15-bed unit. Most patients are accompanied by at times several family members "Water is in short supply, so I give them little plastic bags of water and soap so they can wash their relative."

With her medics she salvaged what she could from the mud-caked debris outside - beds, trolleys, intra-venous poles, anything that would make life easier in the ward.

She has got to know some of her patients well, and through an interpreter has heard their stories. "Jamahlia over there lost four of her daughters in the tsunami and her son is looking after her. She's gutsy, she'll be ok. Halayna in the bed by the door, lost all her children and her husband, her home and her left leg above her knee. You try to cheer them up, but sometimes they just need time to grieve. Wouldn't you?"


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