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After the Tsunmai: Volunteers Help the U.S. Navy to Provide Health Care

Have you ever wondered what it would be like to volunteer your expertise overseas? Eric P. Purdy, MD, responded to Project Hope's call for volunteers to work on a U.S. Navy hospital ship that was being deployed to Banda Aceh, Indonesia. This is his account of that medical humanitarian relief mission.

  • The tsunami. On Dec. 26, a magnitude 9.3 earthquake triggered a devastating tsunami. It killed hundreds of thousands of people within hours . . . (more).
  • Volunteers help the U.S. Navy to respond. As part of the relief effort, the U.S. Navy deployed a hospital ship to Indonesia. The Navy asked Project Hope to recruit volunteers . . . (more).
  • Orientation. The volunteers learned about military ranks, Islamic concerns in medical care and psychological aspects of caring for disaster victims . . . (more).
  • A typical day on the ship. After a 6:30 a.m. breakfast, the volunteers began performing surgeries in the ship's 12 state-of-the-art operating rooms . . . (more).
  • Trips to shore. As they flew into town, the volunteers quietly looked down on the "dead zone," an area 10 miles wide where almost nothing stands anymore . . . (more).
  • Conditions seen. Cases of "tsunami lung" were caused by inhaling large volumes of contaminated, muddy seawater . . .  (more).
  • A successful mission. The naval leadership has been so pleased with the outcome of this mission that they are considering future cooperative missions in the Black Sea region and South America . . . (more).
  • Want to volunteer? If you've considered volunteering overseas but aren't sure how to get started, the Academy's Annual Meeting provides an easy way to learn about the issues. This year's Annual Meeting features two free sessions, informational posters and exhibits, an opportunity to talk to Foundation staff about the Volunteer Registry and six ticketed events . . . (more).

The Tsunami's Devastating Impact
On Dec. 26, a magnitude 9.3 earthquake triggered a devastating tsunami. It killed hundreds of thousands of people within hours. More than 240,000 of the dead and missing lived in the northern Aceh province of Sumatra, one of the many islands that comprise Indonesia.

The province's capital, Banda Aceh, was devastated. Within minutes after the earthquake, 20- to 30-meter high waves roared onto the beaches and into the town, carrying houses, mosques, hospitals, businesses, trees, cars, bicycles, people, animals and possessions away in a huge, turbulent, floating mass. One evening, the Project Hope volunteers viewed a video made by one of the local citizens as the first wave came into town. A quiet street scene was suddenly interrupted by a rolling, boiling 15-foot high wall of water and cars and debris blasting up the city street at what appeared to be about 30 miles per hour. Even now, there are large fishing boats and even a small barge three to five kilometers into town, left behind by the surging water.

  

Volunteers Help the U.S. Navy to Respond
Within days after the December 26 tsunami, the Bush Administration pledged additional support for tsunami relief and asked the armed services to provide transportation of medicine, food, water and supplies, and assist in reconstruction in the affected nations. 

As a part of this relief effort, Operation Unified Assistance was borne. This joint operation involved the rapid deployment of the 894-foot US Navy hospital ship, the USNS Mercy. 

Although it usually takes 60 to 90 days to prepare the ship and stock it for a large scale military or humanitarian mission, it was readied for sailing, stocked with food and medical supplies, and staffed with a Navy crew within four days and sailed from its port in San Diego on January 4. During the one month travel time to reach the distant shores of Banda Aceh, over 8,000 miles away, additional supplies were ordered and shipped though the Naval supply chain, and the required medical and nursing staff requirements were determined.

The Navy asked Project Hope to help provide medical and nursing volunteers to supplement the small Navy medical staff already aboard the USNS Mercy. 

Project Hope (www.projecthope.org) has been providing humanitarian medical care around the world since 1958, and in fact had once owned its own hospital ship, called Hope. Coincidentally, the first maiden voyage and mission for the early hospital ship was the islands of Indonesia. During the recent mission, some of the older inhabitants still had fond memories of the large white hospital ship sailing among the Indonesian islands and providing free medical care to the needy many years ago.

Project Hope contacted specialists at one of the nation's top research and teaching hospitals, Massachusetts General Hospital and asked for volunteers for the medical mission to Indonesia. More specialists were needed and a nationwide call for volunteers went out through the Internet and through various medical specialty societies.  Project Hope's headquarters in Virginia was overwhelmed with thousands of applications and they selected 93 volunteers for the first rotation from February 6 through February 27, and about 110 volunteers for the second rotation, from February 27 through March 20. 

Eric P. Purdy, MD, was asked to participate in the second rotation and left Fort Wayne International Airport on the morning of February 26. The flight from Chicago to Singapore followed a northern route, over the Arctic Circle, then down through Siberia, mainland China, and into Hong Kong for a brief stop, before arriving in Singapore about 24 hours after leaving Chicago. After a brief three hour rest in Singapore, the volunteers traveled by US Navy C-130 transport plane to the local runway in Banda Aceh, Sumatra.  From there, Navy Seahawk helicopters shuttled the doctors and nurses to the Mercy ship in groups of 8 to 10 at a time.

 

Orientation
Finally, on the afternoon of February 28, everyone was aboard and ready for their two days of orientation. This process involved meeting the ship's leadership, including the Executive Officer, Commodore Henry Villareal, and the Commanding Officer, Captain David Llewellyn. Retired Navy Admiral William McDaniel and retired Army General  William Bester served as liaisons between the military and civilian groups working together on the ship. 

The volunteer group also learned about military ranks and discipline aboard the ship, all of the many departments and functions on the ship, and received a detailed tour and orientation to the 1,000-bed hospital within the ship.

The group was also instructed on Islamic concerns in medical care, psychological aspects of caring for disaster victims and their families, and some basic language instruction in Bahasa Indonesian, the primary language of the area. Several local medical students and college students from Sumatra and Jakarta were assigned to assist the mission as translators. They were very motivated and intelligent young people and contributed greatly to the overall success of the mission.

 
 
A Typical Day on the Ship
The volunteers woke up and ate a hearty Navy breakfast at about 6:30 a.m., then reported to their departments within the ship's hospital to begin the day's work caring for hospitalized patients, performing surgeries in the ships 12 large state-of-the-art operating rooms, seeing new incoming patients in the CASREC (Casualty Receiving) area, which resembles a very large hospital Emergency Department trauma unit.

Many patients required the ancillary services available on the hospital ship, including the technologically advanced radiology department with a high-resolution CT scanner, ultrasound and echocardiography instruments, angiography and interventional radiologic services, all provided by a superb Navy Radiologist, Steven Ferrara, MD, and his skilled technologists.  The ship also has a fully functioning hospital laboratory with hematology, clinical chemistry, microbiology, immunochemistry, and surgical pathology services.

In addition, other services available on the ship include physical therapy, four intensive care units, a burn unit, several medical and surgical hospital wards, a pharmacy, a dental clinic, an eye clinic with lens and eyeglass manufacturing lab, oxygen producing plants, and four desalination units capable of producing a total of 300,000 gallons of fresh drinkable water from seawater per day.

Originally, the ship was an oil tanker, then it was converted to a hospital ship in 1986, and served its first humanitarian mission in the Phillipines and South Pacific in 1987, where over 62,000 patients were treated. It also served in the Persian Gulf during Operation Desert Storm, providing medical care to the allied forces. The Mercy is one of two Navy hospital ships. Her nearly identical sister ship, the USNS Comfort, is berthed in
Baltimore.

The civilian volunteers wanted to show their appreciation to the enlisted Navy crew for offering such warm hospitality, and signed up for shifts in the food serving lines and dishwashing room, giving some much-appreciated breaks to the hard working sailors.  The volunteers also signed up for routine maintenance tasks in the bunk areas, such a cleaning bathrooms and showers, and hauling trash. The entire experience gave all of the volunteers a renewed sense of respect and pride in the young men and women serving in uniform. Working with them was indeed an honor. 

Trips to Shore
Those who were selected to travel ashore for the day reported to the "fish bowl," a glass lined office. They lined up in groups, called "sticks", to be transported by helicopter to various locations in the city of Banda Aceh. They provided medical care at the flood-damaged Abidin hospital, at the TNI Indonesian military hospital and at some of the refugee camps on the periphery of the city. At the end of the day, all teams working ashore were transported back to the ship by helicopter, in time for evening dinner in the large cafeteria. 

As they rode into town on the helicopters each day, the volunteers quietly looked down on the "dead zone", an area about 10 miles wide and reaching 1 to 2 miles inland from the beach, where almost nothing stood anymore. Even concrete buildings were blasted off their foundations and now all that remains are the rectangular outlines of where homes, churches, offices, and other buildings once stood.  People were still pasting photocopies of family photos of their lost loved ones onto buildings and walls at the hospital, hoping someone will find them and bring them back home.

Although it is about three miles inland, the Abidin hospital suffered extensive damage in the tsunami, with muddy waters rising up three to four feet in all of the university hospital's buildings, killing most of the patients and many doctors and nurses. The area's other three hospitals that were closer to the shore were completely destroyed, along with most of their medical and nursing staffs. Even before the tsunami, this area was medically underserved, and there was no organized public health service to provide medical care to the indigent patients. Because of that, the doctors aboard the Mercy ship saw a wide spectrum of medical problems, many of which were unrelated to the tsunami.

Although many of the surgeries were performed on board the ship, a large number were performed at the Abidin hospital, once it was cleaned and repaired.  German and Australian military medical camps helped greatly in the restoration of services to the local hospital. 

The Mercy ship provided Navy biomedical technicians and electricians who helped repair flood-damaged x-ray and ultrasound equipment. Several enlisted men from the ship worked for days in 100 degree heat digging trenches for new drainage pipes from the hospital.  Other Naval forces from Guam provided 24 hour protection and security for the ship and for the officers and volunteers working ashore in Banda Aceh. They felt a sense of vulnerability ashore, however, as they were not allowed to bring any firearms into Banda Aceh. (The Aceh region has been immersed in separatist fighting for decades, as the Acehnese rebels have attempted to secure autonomy from the Indonesian
government.)

 

Conditions Seen
During the first rotation of Project Hope volunteers, a larger percentage of patients receiving care aboard the ship had tsunami-related injuries and fractures of legs, arms, and facial bones. Others, such as an 11 year old boy named Iqbal, had "tsunami lung", a  severe aspiration pneumonia, caused by near-drowning and inhaling large volumes of contaminated muddy seawater into the lungs.  Iqbal was near death, and on a ventilator when he arrived on the ship. After weeks of expert lung care and powerful intravenous antibiotics, prescribed by top specialists in Infectious Diseases working on the Mercy ship, Iqbal finally improved, was taken off the ventilator, and walked off the ship with a large smile, along with his only remaining family member to survive the tsunami, his  uncle. Little Iqbal was found by fishermen, nearly unconscious and floating two miles offshore in the Indian ocean, clinging to a piece of driftwood, two days after the tsunami.  His is only one of many stories of tragedy and near-death experiences among the people of Banda Aceh.

The second wave of volunteers arrived nearly two months after the tsunami struck, so they were aware they would mostly be providing primary medical care and seeing many patients with problems unrelated to the tsunami.  The health care needs are tremendous now that several hospitals have been destroyed and many of the region's doctors and nurses were killed in the tsunami.  A wide variety of diseases were encountered, including large tumors of the head and neck and eye socket region, orthopedic and bone deformities, long-standing kidney disorders and tumors, diabetes, glaucoma, dense cataracts causing blindness, parasitic diseases, and leprosy.  Also, about half of the patients and family members coming aboard the Mercy ship were positive for tuberculosis. 

During the mission, Dr. Purdy performed cataract surgeries on adults, young children and infants. He also performed surgery to remove a large orbital tumor from a teenage boy, who presented with severe exophthalmos and hypophthalmos. The Naval pathologist performed histopathologic studies on the tumor and determined it to be a benign primary orbital meningioma. The boy did well following the surgery and was very appreciative to have a normal appearance and normal vision in both of his eyes. Other surgeries performed on the ship included excision of a large corneal limbal dermoid extending into the visual axis, and tarsorrhaphy for a female patient with facial paralysis following resection of a large parotid gland tumor.

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Caption: Chanda Plong, RN, from Massachussetts
General Hospital in Boston, assists Dr. Purdy in
cataract surgery at the Abidin Hospital in Banda Aceh,
as Irma, an Indonesian medical student and translator,
observes and comforts the patient.

Dr. Purdy also worked in a makeshift eye clinic on land in the damaged Abidin Hospital, where the eye team would see up to 300 patients per day, providing eye examinations and eyeglasses, and evaluating patients with disorders, such as glaucoma, injuries, ocular infections, and patients with tropical disorders such as leprosy and trachoma. Several patients were evaluated for tsunami-related ocular trauma, such as penetrating corneal injuries and orbital and facial fractures. Dr. Purdy was assisted in the eye clinic by Navy optometrist, Robert Senko, O.D., and Lieutenants Agosto and McCluster and a civilian optometrist, James Honl, O.D. from South Carolina. 

Other Project Hope team members included specialists from around the country in Optometry, Dentistry, Physical Therapy, Emergency Medicine, Internal Medicine, Infectious Disease, Pediatric Intensive Care, Pediatric Surgery, Nephrology (Kidney Disorders), Urology, Dermatology, Obstetrics and Gynecology, General Surgery, Maxillofacial Surgery, Ear Nose and Throat, and Orthopedic Surgery.  Among the patients treated on the ship were those with severe life-threatening infections, complications from past surgeries, old untreated fractures from previous trauma, and large tumors and growths of the head, neck, face, eye socket, abdomen, pelvis, arms, and legs. 

 

A Successful Mission
The unique cooperative nature of this mission was somewhat of an experiment, to see if military and civilian medical teams could work cooperatively side-by-side in a humanitarian mission environment. The naval leadership has been so pleased with the outcome of this mission that they sent a second cooperative mission back to Sumatra in April and are considering future cooperative missions in the Black Sea region and South America.

The Banda Aceh mission helped to win the United States new friends. With the world's largest Islamic population, Indonesia has been known in recent years for its anti-American and anti-western sentiment, especially since the wars in Afghanistan and Iraq. However, thanks to American assistance to the Indonesian people in recent months, old attitudes may now be changing.  A recent public opinion poll in Jakarta indicated that now, 70 percent more people had a favorable attitude toward Americans than before the tsunami.

During the mission, Dr. Purdy worked with the Captains, Admiral McDaniel, and General Bester in determining what additional surgical supplies would need to be ordered and shipped for an additional series of missions to be performed by the Mercy on its voyage back to its home port of  San Diego. Dr. Purdy offered to contact some U.S. ophthalmic surgical supply companies, such as Alcon Inc. and Bausch & Lomb, to request donated supplies for the additional missions. These companies have provided hundreds of thousands of dollars worth of donated lens implants, medications and surgical supplies for all of Dr. Purdy's other eye surgery missions in Honduras and St. Vincent over the years. Both companies expedited the shipment of all of the requested supplies to the Project Hope headquarters, who then shipped them to Singapore, where the Mercy received them at the Naval shipping port on March 20, just in time for the new missions.

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Caption: As the medical team of volunteers prepares
to depart Adbidin Hospital in Banda Aceh on their last day,
Dr. Purdy and a Naval officer receive farewell smiles
and shouts of  "Terima Kasih", which means "thank you"
in the local language, Bahasa Indonesian.

 

Want to Volunteer?
If you're interested in international assistance but aren't sure how to get started, the Annual Meeting provides an easy way to learn about the issues.

Sunday's free events

  • The speakers at Worldwide, One New Blind Child Every Minute will provide a concise overview of key strategies that are needed to treat children in developing countries (Sunday Oct. 16 from10:30 a.m. to 12:30
    p.m. in Room S406a).
  • Attend this year's International Forum, The Changing Face of World Blindness, to learn about emerging conditions that warrant urgent attention and unsolved challenges that need new solutions (Sunday Oct. 16
    from 2:30 to 5 p.m. in Room S103bc).

For more information—including a list of presenters and the topics that they will discuss—visit www.faao.org, and select "International Assistance."

In the Exhibit Hall

  • Browse the Informational Posters and Exhibits and talk with representatives of nongovernemental organizations that support volunteer projects.
  • Visit the International Assistance Booth in the Foundation's Resource Center to ask about the EyeCare Volunteer Registry, which is currently under development. This will be an online matching program that will help you to find a volunteer that fits your skills and interest.

For more information about international assistance, visit www.faao.org.
 
Six ticketed events

  • Glaucoma in Developing Countries—Breakfast with the Expert #111; Sunday,
    Oct. 16 from 7:30 to 8:30 a.m.—moderator: Alan L. Robin, MD
  • How to Prepare and Conduct a Successful International Volunteer Visit—
    Instruction Course #380; Monday, Oct. 17 from 10:15 to 11:15 a.m.—senior
    instructor: Daniel S. Reshef, MD, PhD
  • Eyes of Africa—Instruction Course #398; Monday, Oct. 17 from 11:30 a.m. to
    12:30 p.m.—senior instructor: Larry Schwab, MD
  • High-Quality, High-Volume, Low-Cost, Sutureless Cataract Surgery: A
    Technique for the Developing World —Instruction Course #543; Tuesday, Oct. 18
    from 9 to 10 a.m.—senior instructor: Sanduk Ruit, MD
  • The Current Global Scenario of HIV-Related Eye Diseases—Instruction Course
    #625; Tuesday, Oct. 18 from 2 to 3 p.m.—senior instructor: J. Fernando Arevalo, MD
  • Cataract Surgery in Developing Countries: Appropriate Technology and
    Techniques—Instruction Course #654; Tuesday, Oct. 18 from 3:15 to 4:15 p.m.—
    senior instructor:  Martin H. Spencer, MD, FRCSC

Tickets for these events go on sale to Academy and AAOE members on June 29; for nonmembers on July 13.

To buy a ticket for one of these events, visit www.aao.org/annual_meeting.