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Handling the dead

Lunanithikul says the Thai government immediately, and repeatedly, announced instructions on TV and radio for working in disaster areas: If you touch a dead body, wear three pairs of gloves and high boots. “Everyone has to drink water from bottles,” she says, and “we’ve injected every volunteer with tetanus vaccine.”

Contrary to popular belief, corpses should not be feared. “When a death is the result of a disaster, the body does not pose a major public health risk for the spread of infection,” according to the Washington-based Pan American Health Organization, which last year released a book titled Management of Dead Bodies in Disaster Situations . Far more worrisome is the possibility of disease from contaminated water.

Pakamas Boranbubpha, RN, was working in a tent at Phuket city hall, dressing wounds and administering antibiotics. She saw 100 to 150 patients a day. “I find infected wounds because the tsunami accident left dirty water,” she says. Many patients had their wounds sutured at a hospital right after the waves hit, but infection still crept in. Celullitis was common.

Some patients came with urinary tract infections, others with upper respiratory ailments. “Some have serious headaches and they cannot sleep,” Boranbubpha says. She was speaking of the signs of an acute problem that could linger months, even years: the psychological aftermath.

Emotional trauma

There is a “dire need for psychosocial treatment resources,” says Dr. Siddharth Shah, MD, MPH, who is working with tsunami victims in India. “Depressive and anxiety disorders leech away people’s ability to get on with their lives. These illnesses diminish quality of life silently.” While experience shows people to be resilient in the face of disaster, many are “caught in vulnerable moments,” he says. “They need attention and adequate services.”

In Thailand, the government plans to keep teams of psychiatrists in affected areas for a year or two, checking on patients and forming a national policy for disaster response. Puchong Lau, MD, says the country has never faced a situation like this. “We have no earthquake, we have no civil war, we have only this.” He studied in medical school about treating patients after disaster. “But the book and the real situation are very different,” he says. “So we must develop new knowledge.”

“I don’t think a lot of people realize how bad it is,” says Baldor, the American whose specialty is psychiatric nursing. She talks of the psychological effects. And she speaks of patients and professionals alike. Foreign patients didn’t want to go home; they wanted to stay and look for lost loved ones. Volunteers grew weary with the long hours. “They were starting to crack, too.”

It’s a stressful, fatiguing job. “Care and support must also be provided for the relief workers,” notes the International Council of Nurses.

To that end, Ripps offers advice: “Bring a few things from home that bring you happiness, whether they are photographs of loved ones, a favorite book of poetry, comfort food, music, spiritual books, a diary, a favorite scented shampoo, or a spare key to a friend’s car. Anything that nourishes your spirit and reminds you of a peaceful place.”

Peace — it’s what every nurse in these devastated places hopes to find, for herself and especially for her patients. Back in the Phuket airport center, Massachusetts nurse Baldor takes a few moments to chat during a lull. It’s quiet now, but she must always be ready. “You have to do what’s put in front of you.”

Sometimes that simply requires a soothing hand. She tells the story of a distraught woman brought to her care. The waves had killed several people in the woman’s family. She couldn’t sleep. She couldn’t find calm. Baldor sat by her head and tried to ease her worries. Eventually, the woman grasped Baldor’s hand, shutting her eyes and lapsing into a tranquil sleep.

She had found a moment’s peace.

“Right now my job is to be here,” Baldor says.

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