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In Vivo

First Person

After the Wave: ER Doctor 
Rushes to Help Victims

Emergency Room physician Rachel Moresky went to Indonesia shortly after the devastating tsunami of Dec. 26. She spent a month in Aceh Utara, a northern province, where she served as a health officer for the International Rescue Committee's (IRC) Mobile Emergency Relief Team. Dr. Moresky provided public health assistance on large-scale measles immunization projects, treated patients in camp clinics and helped set up an ER. Here are some excerpts from her journal.

By Rachel Moresky, M.D., M.P.H.

Rachel Moresky administers measles vaccinations to children at a camp in Indonesia.

Rachel Moresky administers measles vaccinations to children at a camp in Indonesia.

After an exhausting 24-hour flight from New York we arrived in Jakarta in the immediate aftermath of the tsunami. With no idea what to expect, I had brought clothes to wade in water, a personal water filter and a sleeping bag and mosquito tent to serve as a mobile home. We were not sure whether we would be carrying bodies, performing amputations, delivering babies, or working on measles campaigns.

We soon heard stories of kidnappings of doctors by the GAM (the Free Aceh secessionist movement) in the Aceh region; the kidnappings were motivated by the fact that the GAM had no access to medical care and wanted medical personnel to treat their communities and wounded soldiers. We had no way to verify these stories.

Our deployment from Jakarta to Banda Aceh was held up for two days, since there were a plethora of non-governmental organizations [NGOs] and reporters flying there through Medan (the closest major airport). When we finally landed at the military airport in Banda Aceh, I was overwhelmed by both the scale of operations and the seeming chaos that resulted from it. The area swarmed with local and international NGOs whose personnel seemed to possess a singular focus on cleaning and rebuilding. As we drove out of the airport, local residents along the way were mirroring NGO efforts as they swept, scrubbed and rebuilt the wreckage around them in a heroic effort to return their lives and homes to some semblance of normalcy.

Setting up an ER in the Field

Shortly after reaching Banda Aceh, a colleague and I were sent out into the camps to conduct assessments of conditions. Driving through Banda Aceh, we were immediately struck by the unbelievable scale of the devastation – destroyed homes, overturned cars, and fallen trees were a far cry from the once naturally pristine, architecturally diverse and colorful city.

We set up an ER at our first camp, which held about 1,000 internally displaced people. The conditions in the camp did not meet the SPHERE standards – universal minimum standards during humanitarian assistance – for water, sanitation, nutrition, food aid, shelter and site planning, and health services. People were living in makeshift tents with less than 2 square meters between them. Each person had access to less than 2 liters of water per person per day for drinking, washing, and bathing. The lack of water increased the risk of communicable diseases, with poorly positioned makeshift latrines and non-existent waste disposal systems only exacerbating the risk. Because of conditions such as these, a major priority of the relief effort was vaccinating children against measles to prevent an epidemic.

One day, I managed to gather a group of children for vaccinations by taking off on a run through a soccer field and yelling for the children to follow me. Most of the children had never seen a white woman, let alone a very pale one dressed in men's clothing. In the end, I had more than 50 children behind me running to the school where the shots would be administered. We ran past the military camp post with the soldiers leaning on their rifles, smoking and watching bemusedly.

Healing Minds & Bodies

Although people were remarkably warm and friendly, we saw many cases of post traumatic stress disorder. Our translator informed us that our driver, Harry, had lost his entire family – wife, children, parents, and siblings. He had poignantly remarked to our translator that he was too sad to cry. While not crying may be a temporary defense mechanism, what would happen after the first tear was shed? I was relieved to see there was a growing cadre of trained psychiatrists in the area.

I examined Ahyar, a 24-year-old man with jaundice who was weak and had a low-grade fever. Ahyar had walked eight days from Banda Aceh to the west coast of Sumatra, with almost no food or water, looking for his mother. Ahyar had jaundiced eyes and skin, dry mouth and a tender abdomen with an enlarged liver. I had no oxygen, lab or X-ray machine at this clinic. All I could do was put in an I.V. line. I held back tears as I made a pointless decision to transfer him to the main hospital, a tertiary center that would not be able to intubate him if it came to that. The treatment of Hepatitis A is usually supportive, so I was hopeful that if he did not have a secondary infection or an underlying liver disease that he would do well with this type of treatment.

The End of an Extraordinary Month

Our drive back to Banda Aceh, which was supposed to take six hours through the mountains, took much longer because our car broke down four times. After two stops in "garages" and a final scare with our brakes going up a mountain at dusk, we were rescued by the appropriately named NGO, Handicap International. We threw our bags on top of the car and made it to Banda Aceh shortly after dusk. As I took one last refreshing cold water bucket bath in Indonesia, I was reminded that even the mere privacy and dignity of being able to take a bath was a rare luxury that my comrades in the camps could still not afford.

Dr. Moresky's previous work has been in Tanzania, Ethiopia, Kenya, India, Romania and the Middle East and she is currently at work on projects in India and Tanzania.