Ripple Effect
U.S. nurses join medical teams to bring relief to a region transformed by devastating tsunami

By John Leighty
January 17, 2005

Marie Davis, RN, has worked in countries stricken by floods, hurricanes, earthquakes, famine, and war. When disaster strikes abroad, the Salem, Ore., mother of two begins packing her travel bag.

An emergency care nurse for 24 years, Davis is brushing up on infectious diseases for what in late February will be her 38th mission — to provide medical aid and comfort to survivors of the devastating tsunami in the South Asia seas as a volunteer with Northwest Medical Teams.

Swanphi Samarakkody, RN, a pediatric nurse at Kaiser Permanente Oakland (Calif.) Medical Center didn’t wait for a spot with an organized disaster relief group. After the tsunami struck, she booked a flight to the Sri Lankan capital of Colombo, near where she grew up.

“When I saw what was happening, I knew I had to go back and help out any way I could,” says Samarakkody, whose family members survived the tragedy, but the fate of many friends still is unknown. “I know the area, people, language, and customs, so these are barriers I don’t have to overcome.”

Davis and Samarakkody watched in disbelief as the death toll from the Dec. 26 earthquake-generated tidal wave rose above the 150,000 mark. Widespread damage also left about 5 million homeless, hungry, and vulnerable to disease and infection.

Knight Ridder news service reported Jan. 13 that an official document posted in Banda Aceh says nearly 210,000 people inIndonesia are dead or missing, which would raise the toll to more than 270,000.

“As the numbers grew, I began to realize this was a much more catastrophic event than anything I had ever encountered,” Davis says.

She was ready to pack up her mosquito netting, fast-drying clothes, and sturdy shoes and head to the ravaged region, except for one obstacle. All her vacation time had been used on two recent trips — in October, to join a medical brigade in violence-plagued Haiti , and in June, to treat refugees in war-torn Liberia.

Undeterred, Davis negotiated a month off from Salem’s Kaiser hospital, where she works in ambulatory surgery and got a leave from her on-call job in the ED at West Valley Hospital in nearby Dallas, Ore. When she flies out Feb. 24 with a medical team, she believes their services will be needed more than ever to help fight disease, malnutrition, and pneumonia among a population weakened by hunger and stress.

“This is a long-term relief effort and I have enough experience to know that sometimes the first response is not where you’re most needed because the infrastructure to support medical teams is very sketchy,” Davis says. “Medical teams often can’t reach areas because the roads are out. Also, infectious diseases haven’t really hit yet. But they will.”

The aftermath

Outbreaks of diarrhea from drinking contaminated water are on the rise, along with some cases of measles, Davis says. A major job of the volunteer medical teams in the country is surveillance to guard against epidemics of malaria, cholera, typhoid, and hepatitis A.

Although the biggest long-term fear is over waterborne diarrhea-related diseases such as cholera and typhoid, no early outbreaks have occurred, which surprises health workers. A possible explanation is the “salt water bath” from the seawater acted as an antiseptic to kill the bacterial strains, says Lynn Gilbert, RN, PhD, PNP, a certified pediatric nurse practitioner at the University of Colorado School of Nursing who has worked in Africa and the Caribbean.

Gilbert speculates that coastal villagers also might have developed some immunity to low-level exposure to the disease-causing bacteria because of their typical lack of access to clean water.

Once diarrheal disease does strike, however, it can be highly contagious and spread rapidly without a sufficient clean water supply to rehydrate the body of lost fluid, she says.

Although measles isn’t usually fatal, Davis says that secondary infections of the eyes, ears, and upper respiratory system can be deadly, particularly in undernourished children. Pneumonia is also a constant danger in crowded refugee camps that are being pelted by rains.

While Davis calmly waits for her departure date, Samarakkody flew to Colombo on Jan. 10, but not before Kaiser officials asked her to be their advance contact for the first of several medical teams being assembled to go to the region.

“Once there, I’ll be the ground correspondent to help Kaiser get organized,” says Samarakkody, who came to California from Asia to attend nursing school at Contra Costa College, later joining Kaiser where she’s worked for four years.

Samarakkody says she’ll also work with other organizations in Sri Lanka during her three-week stay, which might be extended. She says a big need is for trauma counseling, a field in which she’s trained. One group she’s hooking up with is the California Nurses Association, which helps support a hospital in Colombo that’s overwhelmed with patients.

The CNA donated several thousand dollars from its emergency fund to the public nurses union in Sri Lanka to equip vans with medical equipment for transporting aid to isolated regions. About 200 CNA nurses also volunteered to travel to the Southeast Asian coast, where hospitals are usually overflowing because of a severe shortage of nurses.

Meanwhile, Kaiser Permanente Northern California is working with the relief agency Doctors Without Borders to send medical teams and supplies to the hardest-hit regions. More than 200 physicians, nurses, and other Kaiser medical personnel have volunteered, Kaiser spokeswoman Alix Sabin says.

Kaiser also has donated $1 million to relief efforts, the largest portion of $500,000 going to Doctors Without Borders for its public health and medical care services. Another $250,000 went to the American Red Cross, which provides emergency aid, and $250,000 went to Operation USA, which handles shipments of supplies.

Help is on the way

Fueled by an unprecedented outpouring of private donations reaching hundreds of thousands of dollars, dozens of relief and humanitarian organizations geared up to send medical aid, personnel, and supplies to revive regions flattened by the powerful sea surge the day after Christmas.

While nurses across the country scrambled to volunteer their services in the tsunami’s aftermath, finding a sponsor isn’t easy. One of the largest agencies, the Red Cross, relies on its international network of chapters to supply emergency response teams in their areas.

The organization does maintain a call-up roster that includes nurses willing to go through a training course to assist in local disasters, says Mila Fairfax, spokeswoman for the American Red Cross Bay Area in San Francisco. Only 11 Red Cross volunteers were dispatched to the tsunami area from the United States, she says, including Jim Stephenson of Mill Valley, Calif., a supply logistics expert.

Doctors Without Borders is accepting only volunteers with training and experience in disaster relief, although the “Flying Docs” will sometimes take a nurse specialist on a maiden mission.

Nurses who feel a calling for relief work often can often sign on with a variety of relief organizations as well.

In Encinitas, Calif., Surf Aid International assembled a team of physicians, nurses, and health care professionals from California, New Zealand, and Australia, and sent it Jan. 8 to the small Indonesian island of Nias, a popular surfing destination that was swamped by the tsunami, killing hundreds. The team’s task is to assess damage, provide medical treatment, and teach islanders about hygiene, and ways to treat and prevent diseases such as typhoid, cholera, and malaria.

That same day, Santa Monica-based International Medical Corps dispatched a team of 25 trauma-specialist physicians and nurses to Banda Aceh, Indonesia, which was the closest town to the magnitude-9.0 undersea earthquake that triggered the tsunami and has become “ground zero” at the northern tip of Sumatra.

With much of the region’s health care system wiped out, including most of its medical personnel, wiped out, many tsunami victims need amputations because of festering wounds that have gone untreated and turned gangrenous, says Stephen Tomlin, IMC vice president of program policy and planning.

IMC has a core group of native health care workers in the region, Tomlin says, but the destruction overwhelmed them and they asked for help with the “walking wounded,” some of whom were trapped for days under debris. A field report from a region east of Banda Aceh reported that only 89 people were left alive in one village of 1,000, he says.

The team — from a roster of volunteers who agree to go to disaster areas with a 72-hour notice — includes four California nurses:

• David Gantz, RN, Lafayette, an ED nurse from Alta Bates Summit Medical Center in Berkeley.
• Jeanie Schmidt, RN, San Jose, a staff nurse from Kaiser Permanente in Oakland.
• Ashley Garcia, RN, San Pedro, a trauma and ED nurse from Harbor-UCLA Medical Center.
• Andrea Gillespie, RN, a nurse anesthesiologist from Family Planning Associates Medical Group in Long Beach.

“The nurses are flexible, resourceful, and valuable,” Tomlin says. “They help with cleaning infections and amputating, whatever is required.” A second medical team is being assembled for a similar three-week deployment, he says.

In San Diego, the Navy hospital ship USMS Mercy set sail Jan. 5 for the Indian Ocean after William Bester, a retired brigadier general and a faculty member at the University of Texas School of Nursing at Houston, was chosen to head a group of nurse volunteers when the ship reaches the Indonesian coast early next month.

Bester, the first male chief of the U.S. Army Nurse Corps, was recruited by Project Hope and the U.S. Navy to direct the volunteer mission on board a ship that has 12 operating rooms, 1,000 beds, radiological services, a medical laboratory, a pharmacy, an optometry lab, a CT scan, and two oxygen-producing plants.

Davis, who wanted to join the Peace Corps as a young girl and earned her nursing degree from Chemeketa Community College in Salem, says she’s often contributed her own airfare to trouble spots during her 20 years with Northwest Medical Teams, which has so far sent seven medical teams to South Asia.

Married with two young daughters, she made her first medical trip in 1985 to Ethiopia, where for six weeks she was one of four nurses in a refugee camp of 100,000 people uprooted by famine and war.

“I spent most of the first four days crying, wondering ‘How I am going to do this?’ And then I got down to work and just worked and worked,” says Davis, who treated many children with cholera, meningitis, and bad burns from falling in cooking pots. “We saved a lot of lives, had a lot of small victories.”

For nurses who want to volunteer for what is tough, rewarding work, she recommends several years of hospital practice and some experience in developing countries. An openness to experience other customs and embrace more of the world also is essential.

“If you have the heart to serve, it’s an unbelievable opportunity,” says Davis, who reads up on the culture, climate, geography, and religions of the country she’s visiting.

“It’s like a classroom out there, and if you’re in nursing to serve, it fulfills that need.”

RN volunteers sought for tsunami relief

Project HOPE is organizing U.S. health professionals interested in volunteering in the disaster relief efforts in South Asia, according to the ANA.

The first 30-day volunteer humanitarian assistance mission will leave Jan. 26 aboard the U.S. naval ship Mercy. Other 30-day missions will follow during the next three months.

The ANA said ProjectHOPE is most interested in RNs and advanced practice registered nurses who are currently practicing in clinical nursing. Specialties needed include: OR, Medical/Surgical, ICU/CCU, Triage, Infectious Disease, Pediatrics, Wound and Ostomy, Labor and Delivery, and NICU/PICU.

To apply, send a résumé to recruitment@projecthope.org and note “Tsunami Relief” and your specialty in the subject line and your availability in the text. If you are unable to submit your résumé by e-mail, you can fax it to (540) 837-9052.

For updates, visit www.nurseweek.com.