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Waves of Relief : From major surgery to treatment of chronic illnesses, volunteers aided more than 9,000 tsunami survivors

William Bester never really had a full appreciation of water until Feb. 4, 2005.

On that day, The University of Texas at Austin nursing professor and other American medical volunteers from the USNS Mercy arrived off the coast of Banda Aceh, Indonesia and witnessed first hand just how powerful and devastating it can be. 

Indonesia suffered the greatest number of casualties in the tsunami. This mosque was the only thing left standing after the giant waves hit the area.
Indonesia suffered the greatest number of casualties in the tsunami. This mosque was the only thing left standing after the giant waves hit the area.

The December great sea wave or tsunami had killed about 130,000 people in the region, wiped out a local hospital and leveled most of the housing and other structures.

“The devastation reminded me of photographs I had seen of Hiroshima,” said Bester, a retired 54-year-old brigadier general and first male to serve as chief of the U.S. Army Nurse Corps. He joined the university’s School of Nursing in 2004. “You can’t fully describe absolute ruin in words.”

Bester was recruited to lead the nursing staff of the medical relief team on board the Mercy, a U.S. Navy hospital ship. Project HOPE, a non-profit organization with a history of shipboard assistance efforts, provided the majority of healthcare professionals for the relief mission.

The tsunami and people whom it affected are still very much on the minds of those who served on the humanitarian mission. The six-month anniversary of the event was last week, and Bester recently returned from an “after-action” meeting with the USNS Mercy and Pacific Fleet leadership in Pearl Harbor.

“This was the first time American citizens had worked with the military—via the Mercy—and all in all, it was considered a great success,” Bester said.

As the advance party commander to deploy the first hospital into the Balkans during Operation Joint Endeavor in 1995, Bester had seen destruction in the form of burnt out villages, “but never anything like this. So much of Banda Aceh had just been leveled. Rarely did you see even the shell of a house. It was very disturbing.”

The tsunami destroyed much of the region’s fishing fleet, sending some boats crashing up into Banda Aceh.
The tsunami destroyed much of the region’s fishing fleet, sending some boats crashing up into Banda Aceh.

The medical team was astounded by much of what they saw when they got ashore.

A huge barge—four stories in height—had been sitting off Banda Aceh when the tsunami carried it two miles into the city and dropped it.

A 100-foot tall monument at the edge of the shore was still standing, but its light fixture at the very top was gone, swept away by one of the waves.

“It was surreal,” said university nursing graduate student Ronda Schultz, who also volunteered for the Mercy mission. “It looked like I would imagine another planet would look. There were foundations of homes, complete with tile floors, and some things sticking up like fireplace corners or steps, but otherwise it was totally devastated. Wiped clean.”

In two rotating groups, the team of 200 registered nurses, physicians, oral surgeons, veterinarians, optometrists, nurse practitioners, social workers, dieticians, translators and administrative personnel worked for several weeks to provide medical care for the tsunami survivors.  Nurses made up more than half of the total number of volunteers and 11 nurses from the first rotation opted to stay for the second.

“This says a lot about the field of nursing,” Bester said.

Dr. Dolores Sands, dean of the School of Nursing, said the opportunity for nurses “to help the less fortunate, particularly after such a tragic event, demonstrates their courage and the extent of their capabilities.

School of Nursing professor Bill Bester on board the USNS Mercy
School of Nursing professor Bill Bester was recruited by Project HOPE to lead the nursing staff on board the USNS Mercy. Nurses made up more than half of the total number of volunteers.

“Bill and Ronda are credits to their profession as nurses and to the university. When they returned to Austin and told the faculty and students of their experiences in Indonesia—we were absolutely spellbound.”

The experience was life changing for all those on board.

“There are so very many stories I could tell,” said Schultz, a registered nurse working on her master’s degree. “I was blessed to have been able to participate in this mission. I stayed for both rotations and worked with just about every patient who came on the ship.”

The earthquake that caused the tsunami was the fourth largest in the world since 1900, according to the U.S. Geological Survey. More than 283,000 people were killed, 14,100 are still listed as missing and more than 1 million were displaced. The tsunami caused more casualties than any other in recorded history and was recorded nearly worldwide on tide gauges in the Indian, Pacific and Atlantic oceans. Indonesia suffered the greatest number of deaths.

Initially, those on board the ship had intended to attend to the wounded in Indonesia, Sri Lanka and Thailand.

“But once we got to Indonesia and realized that the damage was so colossal, the decision was made to stay in Banda Aceh,” Bester said.

Unlike war, where soldiers are often treated within an hour of their injury, Bester and his group came face to face with patients who had been walking around for weeks with broken bones and other injuries. Many had fashioned homemade splints out of whatever they could scavenge—boards, small bamboo shoots, scrap lumber and pieces of plastic and cloth.

Ronda Schultz with a 15-year-old girl on board the Mercy
Ronda Schultz, a University of Texas at Austin nursing graduate student, volunteered for both rotations. She is pictured here with a 15-year-old girl who has bone cancer and had to have her arm amputated. In addition to treating tsunami-related injuries, the medical volunteers also helped people with other illnesses.

“Their pain tolerance was incredible compared to what we see within the American culture,” Bester said. “Even post-operatively, these patients required or requested very little, if any, pain medication.”

The Mercy, a gleaming white 900-foot-long ship with a painted red cross, was equipped with 1,000 hospital beds and 12 operating rooms.

During the mission the medical staff treated 178 inpatients and 9,202 outpatients. There were 285 surgical procedures, 1,758 radiological procedures, including C-T scans, 4,806 prescriptions filled, 654 dental exams and 1,315 dental extractions, 220 immunizations and 4,806 optometry exams. Four thousand pairs of glasses were given out. The two veterinarians were on the trip for public health/food inspection/animal control consultation and guidance.

One tsunami survivor, with 12 facial fractures, underwent a 13-hour operation on board the ship. The power of the waves was responsible for the large number of facial fractures. Several of the patients had developed aspiration pneumonia or “tsunami lung” from ingesting seawater and ended up on ventilators in the ship’s intensive care units.

Bester said he also saw his first case of tetanus “and it was far, far worse than anything I had pictured.” One patient with tetanus died. There were two cases of polio and several cases of tuberculosis. But, the medical team did not see other infectious diseases like cholera, malaria, typhoid and dengue fever, as expected. U.S. Marines provided a large source of clean drinking water that probably prevented some disease outbreaks, said Bester.

Tsunami survivor with a homemade splint on his arm
Many victims of the tsunami, like this man who broke a bone in his arm, made homemade splints out of whatever they could scavenge.

The volunteers spent the first two weeks treating tsunami-related injuries and the rest of the time helping patients with more chronic conditions. Because of the lack of available or affordable healthcare in the region the volunteers were inundated with chronic medical and surgical cases.

The Mercy staff surgically treated a number of patients, who had large tumors, some benign and some malignant. Many of the tumors they treated were in the facial and neck areas. Patients seen by the Mercy-Project HOPE staff were frequently dehydrated and many were malnourished, Bester said. 

“We did send some patients away that we couldn’t treat—either because we didn’t have the required skills on board or because there was absolutely no way the patient could get the required medical follow-up,” said Schultz. “Medical intervention in those situations would have been inappropriate.”

One of the ship’s exam rooms had been converted to a children’s room for play and community therapy. The area was filled with art—sketches and drawings by the young patients on the ship. Some pictures, said Schultz, were very sobering—like a drawing of a truck carrying off bodies—while others were inspirational.

She remembers one boy who lost 35 members of his family in the tsunami and another who nearly died from a burst appendix.

“He and his father were the only survivors of the tsunami in their family because they had gone out fishing that morning,” she said.

“I fell in love with the people over there,” Schultz said. “They are gracious, kind and strong. And, still numb from what happened.”

One of the translators summed up the problems the people of the area face in a moving speech to the medical volunteers on the last night.

“These people who you have been treating are the poorest of the poor,” said the interpreter. “They eat chicken or meat perhaps once a year. If they eat fish twice a week that is really good. Normally, their meal will be a plate of rice with some chili peppers and a bit of swamp spinach or other vegetable.”

U.S. aircraft carrier Lincoln alongside the Mercy
The U.S. aircraft carrier Lincoln was in the vicinity at the time of the tsunami and provided whatever immediate support they could—food and clean water—until the Mercy arrived.

The people are often caught in the crossfire between the military and separatists.

“Indifference is often the best they can expect,” said the translator. “And then they came here. Here you not only healed their bodies, but you treated them with such gentleness, such compassion and such great courtesy.

“For the first time in their lives, they were treated as human beings who have worth. You see a man who has lost an arm, a patient who has lost a leg—and, yet, when they leave the ship they are all smiling. They are perhaps happier than they have ever been in their lives because for the first time they are aware of their worth as people and that their thoughts and feelings and lives count. They leave with self-esteem. This is something very special and very rare that you have given them.”

Four helicopters supported the Mercy and each day about 25 to 40 medical personnel were brought ashore to treat and triage patients. Patients who needed more care were brought to the ship escorted by a family member. Each night, for security reasons, the ship would go out to sea 40 miles and then return the next morning.

The medical volunteers slept in an open-bay environment with 60 to 70 other individuals. There was little opportunity for private quiet time.

They also worked to get the city’s university hospital, which had been buried under three feet of mud, back in working order so it could return to providing care for the local residents. The tsunami had killed all the hospital’s 300-plus patients and a third of its medical and nursing staff. The salt water destroyed the facility’s medical and diagnostic equipment. The university hospital is the only teaching hospital in the region.

Young boy, Fadhil, was originally brought to the ship after a mo-ped accident
A little boy, Fadhil, was originally brought to the ship after a mo-ped accident. A tumor, however, was found on his liver—and thanks to an American benefactor—he was brought to Massachusetts General Hospital in Boston for an operation. Fadhil, who lost most of his siblings in the tsunami, is going to be fine.

And, members of the Mercy staff were involved in outreach programs to area villages, providing maternal/child healthcare, immunizations and preventive medicine.

The trip was successful from two points of view, Bester said.

“We treated a number of victims from the tsunami in addition to a number with chronic medical and surgical conditions,” he said. “And, we were able to show the people of that region of the world what Americans are all about—caring, compassionate, giving people.”

When they first arrived, there was great skepticism about Americans, Bester said.

“Some were afraid they’d go on the big white ship and never come back,” he said. “Most people had never met an American.

“Once the people had the opportunity to experience the American people through the work of these selfless healthcare providers from all around the United States, there developed a bond and a friendship that I believe will remain in this region for years to come,” Bester said.

“It was not uncommon to see patients and their family members leaving the ship flashing smiles and exchanging hugs and tears with members of the medical team.” 

BY Nancy Neff

PHOTOS courtesy Project HOPE/U.S. Navy healthcare team

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  Updated 2005 July 11
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