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After the tsunamis
World Report
After the tsunamis The Lancet emailed 300 doctors in southeast Asia to gauge how medical services are responding to the Dec 26 tsunamis. The three accounts below were selected from the numerous responses. They each provide a valuable medical insight into a tragedy that has absorbed the entire world.
As the tsunamis were totally unexpected, very extensive, and happened on a public holiday, it took some time for the government machinery to get going in the relief effort after the tsunamis hit. Initial efforts were mostly by local residents. The 20 min duration of the tsunami waves meant those with major injuries probably drowned; the survivors had a variety of minor injuries, but only few major ones. By the time medical help arrived in some areas, many abrasions and tissue injuries were infected. Treating these wounds required a huge quantity of drugs, which led to shortages of antibiotics in troubled areas. Quickly, however, these shortages were addressed. Respiratory tract infections and pneumonias were common several days after the tsunamis among people who had come close to drowning. Some cases of gastroenteritis, measles, and chicken pox were reported in camps, but as yet no diseases have reached problematic levels. Patients with chronic diseases, such as bronchial asthma, diabetes mellitus, and hypertension had difficulties in controlling their diseases as emergency medical help did not include drugs for such conditions. Later, though, this too was addressed. Acute grief reactions among survivors vary according to the extent of family losses, but psychological and psychiatric support will be essential in the medium term. The long-term effects of the disaster on medical services will be minimal, but rehabilitating the homeless will be important in preventing the psychological and social sequelae that affect medical issues.
Chansak Wacharong, Bovornrit Chukpaiwong, Banchong Mahaisavariya www.thelancet.com Vol 365 January 15, 2005
This information was collected by Inge Sutanto from her colleague Tjut Mariam Zanaria, a lecturer who lives in Banda Aceh
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Reuters
Colombo, Sri Lanka
On Sunday Dec 26, 2004, we felt a strong earthquake of 8–9 Richter at 8·25 am. It lasted for around 6–7 min. Suddenly, the sea level shrunk right away from the shore, and many people went to collect the fish that were left exposed on the dried sea. At 9 am, there was an explosion followed by very high waves which hit the houses along the shore of Banda Aceh and extending around 3 km inland. Panic-stricken people ran to get away from the muddy blackish water. The waves looked like a giant tongue which engulfed and destroyed every single thing. After 20 minutes, the waves gradually disappeared, leaving 20–30 cm of thick mud, dead bodies, and collapsed buildings lying on the shore line. The from before my house. Many of my relatives lay dead under collapsed houses. Medical aid is sufficient in Banda Aceh itself, but in isolated areas the situation is different especially in areas where helicoptors have difficulty getting access. The major medical problems are physical injuries, psychological problems, respiratory infections, bone fractures, and skin diseases. Most of the local health attendants are either dead, have moved to other areas, or have lost their houses and family members. As a consequence, the local public health services are inoperable.
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Reuters
Banda Aceh, Indonesia
The tsunami attacked the western coast of the southern part of Thailand. Our hospital, Takuapa hospital of Phang Nga province, located 3 km inland, was the most severely affected. It is a general hospital with 180 beds, and is staffed by only 10 doctors, including 5 general practitioners, 2 orthopaedists, 1 surgeon, and 2 paediatricians. All staff were called to take care of patients at the emergency room when the casualties started arriving. More than 1000 patients came to the emergency room during the first 24 h. The hospital had space for only 50 to 60 casualties. All doctors joined in with first aid management, resuscitation, and identification of patients that required surgical debridement. Most of the 140 patients that needed surgery had infected wounds. These lesions were severely contaminated, greyish in colour, contained with sand and mud, and were foul-smelling. Some wounds had only small opening tracts but inside there were cavities that contained lots of contaminants such as sand, soil, and wooden splinters. Communication via telephone was not possible until several hours after the tsunami, but the messages requesting help were carried by ambulance drivers to medical staff at the provincial hospital. With only four operating theatres, it was impossible to operate rapidly on those who needed it. Almost all wounds were treated late, which meant they became infected. By the morning of Dec 27, medical teams, physicians, and many organisations from Bangkok came to assist the staff at Takuapa hospital.
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Reuters
Phang Nga, Thailand
SPW Kumarasinghe 203
After the tsunamis The Lancet emailed 300 doctors in southeast Asia to gauge how medical services are responding to the Dec 26 tsunamis. The three accounts below were selected from the numerous responses. They each provide a valuable medical insight into a tragedy that has absorbed the entire world.
As the tsunamis were totally unexpected, very extensive, and happened on a public holiday, it took some time for the government machinery to get going in the relief effort after the tsunamis hit. Initial efforts were mostly by local residents. The 20 min duration of the tsunami waves meant those with major injuries probably drowned; the survivors had a variety of minor injuries, but only few major ones. By the time medical help arrived in some areas, many abrasions and tissue injuries were infected. Treating these wounds required a huge quantity of drugs, which led to shortages of antibiotics in troubled areas. Quickly, however, these shortages were addressed. Respiratory tract infections and pneumonias were common several days after the tsunamis among people who had come close to drowning. Some cases of gastroenteritis, measles, and chicken pox were reported in camps, but as yet no diseases have reached problematic levels. Patients with chronic diseases, such as bronchial asthma, diabetes mellitus, and hypertension had difficulties in controlling their diseases as emergency medical help did not include drugs for such conditions. Later, though, this too was addressed. Acute grief reactions among survivors vary according to the extent of family losses, but psychological and psychiatric support will be essential in the medium term. The long-term effects of the disaster on medical services will be minimal, but rehabilitating the homeless will be important in preventing the psychological and social sequelae that affect medical issues.
Chansak Wacharong, Bovornrit Chukpaiwong, Banchong Mahaisavariya www.thelancet.com Vol 365 January 15, 2005
This information was collected by Inge Sutanto from her colleague Tjut Mariam Zanaria, a lecturer who lives in Banda Aceh
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Reuters
Colombo, Sri Lanka
On Sunday Dec 26, 2004, we felt a strong earthquake of 8–9 Richter at 8·25 am. It lasted for around 6–7 min. Suddenly, the sea level shrunk right away from the shore, and many people went to collect the fish that were left exposed on the dried sea. At 9 am, there was an explosion followed by very high waves which hit the houses along the shore of Banda Aceh and extending around 3 km inland. Panic-stricken people ran to get away from the muddy blackish water. The waves looked like a giant tongue which engulfed and destroyed every single thing. After 20 minutes, the waves gradually disappeared, leaving 20–30 cm of thick mud, dead bodies, and collapsed buildings lying on the shore line. The from before my house. Many of my relatives lay dead under collapsed houses. Medical aid is sufficient in Banda Aceh itself, but in isolated areas the situation is different especially in areas where helicoptors have difficulty getting access. The major medical problems are physical injuries, psychological problems, respiratory infections, bone fractures, and skin diseases. Most of the local health attendants are either dead, have moved to other areas, or have lost their houses and family members. As a consequence, the local public health services are inoperable.
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Reuters
Banda Aceh, Indonesia
The tsunami attacked the western coast of the southern part of Thailand. Our hospital, Takuapa hospital of Phang Nga province, located 3 km inland, was the most severely affected. It is a general hospital with 180 beds, and is staffed by only 10 doctors, including 5 general practitioners, 2 orthopaedists, 1 surgeon, and 2 paediatricians. All staff were called to take care of patients at the emergency room when the casualties started arriving. More than 1000 patients came to the emergency room during the first 24 h. The hospital had space for only 50 to 60 casualties. All doctors joined in with first aid management, resuscitation, and identification of patients that required surgical debridement. Most of the 140 patients that needed surgery had infected wounds. These lesions were severely contaminated, greyish in colour, contained with sand and mud, and were foul-smelling. Some wounds had only small opening tracts but inside there were cavities that contained lots of contaminants such as sand, soil, and wooden splinters. Communication via telephone was not possible until several hours after the tsunami, but the messages requesting help were carried by ambulance drivers to medical staff at the provincial hospital. With only four operating theatres, it was impossible to operate rapidly on those who needed it. Almost all wounds were treated late, which meant they became infected. By the morning of Dec 27, medical teams, physicians, and many organisations from Bangkok came to assist the staff at Takuapa hospital.
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Reuters
Phang Nga, Thailand
SPW Kumarasinghe 203