This weeks feature : Médecins Sans Frontières Australia

July 2006

JAVA EARTHQUAKE: REHABILITATION OF THE WOUNDED STILL A PRIORITY

© Jean-Pierre Amigo

Médecins Sans Frontières (MSF) intervention came to complement the rapidly deployed local emergency response. IT focused on 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 on Saturday, May 26 this year, killed 5760 people and injured 37339 thousand people more according to the latest official figures. Local emergency teams responded quickly, carrying out around 5000 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.

MSF field hospital
Over 100 post-operative patients requiring further hospitalization have been transferred to the MSF field hospital from all of Yogyakarta’s main hospitals. Indonesian and MSF teams provide medical follow up, nursing care, as well as physiotherapy for their rehabilitation as well as psychological consultations.

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 orthopaedic surgeon together with the rest of the emergency surgical team carried out an average of 5 major surgical interventions a day in one of the Yogyakarta hospitals. In this way, our team, alongside other international and national surgical teams, were 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, as well as 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.

Physiotherapy for recovery
An MSF physiotherapists visits homes to find patients in need of follow up. MSF has set up two clinics in Bantul to provide phystiotherapy, dressing changes and medical follow up for patients living in the area, and to refer cases to the hospital if necessary.

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 organised 14 mobile clinics to roam affected villages and identify patients who require additional care. Together with the health authorities, MSF medical teams carry out house visits in the most affected villages, and in the past few days has 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, whilst those needing further surgery are reffered to the Indonesian hospital of Sardjito.

Identifying patients still in need of medical follow up
Medical teams visit affected villages and identify patients who require additional medical care. Many of these patients live under plastic sheeting and tents in the ruins of their homes. To complement this strategy, MSF has just opened two out patient 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,” concludes 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.”

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