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Java Earthquake – Rehabilitation of the Wounded Still a Priority
July 4, 2006
Doctors Without Borders/Médecins Sans Frontières' (MSF) intervention following the May 27 earthquake has focused on complementing the rapidly deployed local emergency response by providing surgery, post-operative care, and physiotherapy in order to help people recover from their wounds and regain their autonomy as quickly as possible.
Kabul is 82 years old. He was sweeping his house in the town of Bantul when the ground beneath his feet began to shake and the roof crumbled. He made a dash for the door but a heavy beam fell on his leg, pinning him to the ground. "I was terrified," he remembers. "My mind went blank and all I could think of was the unbearable pain." Most houses in Bantul, the area most severely damaged by the earthquake, are constructed with light materials, and so the majority of victims could be rescued from beneath the rubble within hours. However, many had sustained broken bones.
The earthquake that hit Yogyakarta killed 5,760 people and injured 37,339 thousand people more according to the latest official figures. Local emergency teams responded quickly, carrying out around 5,000 surgical interventions and treating the most urgent wounds within the first few days following the earthquake. However the hospitals were overwhelmed by the enormous number of patients, making it difficult to provide proper post-operative care for their recovery.
Surgical and Post-operative Care
MSF reasoned it could be most effective in supporting the Indonesian emergency response mechanism by focusing its efforts on surgery and post-operative care. During two weeks an orthopedic surgeon together with the rest of the emergency surgical team carried out an average of five major surgical interventions a day in one of the Yogyakarta hospitals. In this way, our team, alongside other international and national surgical teams, was able to work through the back-log of patients who had not been operated on immediately after the earthquake due to the large influx of wounded.
Kabul was one of these patients, and like him, many patients need to remain hospitalized for several days or weeks in order to recover properly from the operation. However, in the first few days following the earthquake many patients were discharged from the hospitals sooner than is normally recommended due to the overcrowded conditions in the hospitals, and now run the risk of developing infections or further complications.
To solve this problem MSF constructed a post-operative field hospital in downtown Yogyakarta. Over 100 post-operative patients requiring further hospitalization have been transferred from all of Yogyakarta's main hospitals, most of them coming from the hospital of Sardjito. Indonesian and MSF teams provide medical follow up, nursing care, physiotherapy for their rehabilitation, and psychological consultations if necessary. The post-operative field hospital is a temporary structure consisting of interconnected tents fully equipped with electricity, running water, latrines and a pharmacy. Once patients are well enough to be discharged they are provided with basic relief items to help them settle back home, and more patients are then transferred into the hospital.
Responding to Specific Needs
Another priority is finding the patients who were discharged too quickly from the hospitals in the days following the earthquake and who returned to their villages. Indonesian health authorities have organized 14 mobile clinics to roam affected villages and identify patients who require additional care. Together with the health authorities, MSF medical teams carry out home visits in the most affected villages, and in the past few days have found 70 additional patients in need of physiotherapy. Another 20 patients have been found in need of additional surgery. Those needing to be hospitalized again are referred to the MSF field hospital in Yogyakarta, while those needing further surgery are referred to the Indonesian hospital of Sardjito.
To complement this strategy, MSF has just opened two outpatient clinics in the Bantul area where most of the wounded come from. In this way, people who no longer need hospitalization are still able to come to the clinics for dressing changes, physiotherapy and medical check ups.
"Because of the impressive local response there has not been a need for MSF to intervene on a large scale," says MSF Emergency Coordinator Fabrice Resongles. "But there were gaps we could fill. Hospital support, post-operative care, and physiotherapy were clearly identified specific needs we have responded to in order to help patients regain a semblance of a normal life far more quickly than they would do otherwise."