Tsunami TLC
Thai and international nurses dispense ingenious solutions
for traumatized survivors
By Karen J. Coates
January 31, 2005
These days, the ocean laps calmly against southern Thailand’s shores. The sun sets on quiet beaches; the air smells tropical. This is what people love, why they call it paradise.
No one expected a schizophrenic sea to rise against the coast the day after Christmas, swallowing people, homes, hotels, boats, everything. There was no master plan for the aftermath. No hospital blueprints, no step-by-step guides telling nurses and doctors how to handle more than 8,400 injured and 5,000 dead.
“I was ready for the conditions, but what scared me: so many dead,” says Sripoapai Lunanithikul, RN. As head of emergency nursing at Wachira Hospital in Phuket, a Thai island that attracts more than 3 million tourists each year, she helps her staff train for plane crashes, ship wrecks, fires, floods. “Every kind of accident,” she says. But not on such a monstrous scale.
Immediately after hospital staff heard about the deadly waves, Lunanithikul says, they called around the country for help. “Doctors, nurses and other departments all came right away.” Within minutes, health workers were dispatched from Bangkok, far-away provinces, private hospitals, the Navy. “We had many ambulances from other places.”
Foreigners came, too. “It’s been an amazing response,” says Kate Baldor, RNCS, an instructor at Worcester State College in Massachusetts. She was vacationing in Bangkok when disaster struck. When the news broke, she hooked up with an international relief team and headed south.
Baldor landed in Phuket, at an airport-hangar-turned-relief-center for patients awaiting evacuation flights home. “We have had fresh water, food, everything we’ve needed,” she says. Everywhere, supplies: empty beds with IV drips, trunks of medications, stacks of bottled water, a table full of noodle cups, fried chicken and rice, water hot and cold, drink boxes, apples, backpacks. Amid all this, a female patient with a patched up leg is wheeled down the ramp and lifted into an ambulance, en route to an evacuation flight headed for Germany.
Helping hands
By most accounts, Thailand has been lucky throughout — plenty of love and compassion, quick hands and sharp thinking, food and water readily available, working phones and computers, medicines on hand. Baldor calls the relief effort “oversupplied rather than undersupplied.” The worst of life rallied the best of people’s spirits.
Many of the first workers on scene had no medical training, but did what they could to help the injured. “There were thousands of helpers,” says Walter Dreier, an Austrian with no medical background who spent days picking through muck, searching for bodies in Thailand. “They say if this happened in Austria, they are not sure they could handle it like the Thais.”
He witnessed the transformation that followed in the disaster’s wake. Aid stations sprouted from ravaged fields. Government offices became meeting points, and hospital waiting rooms turned into telecommunications hubs. Ingenuity was the rule.
And ingenuity became the nurse’s mandate — bridging language barriers and diagnosing in the field, without tools. Lunanithikul says preparing patients for 12-hour flights to Europe required imaginative thinking. “We just improvised,” she says. “When they were very sick, they couldn’t get up. We didn’t have enough urine bags, so we had to modify. 85 We tied a bottle around a man,” while female patients were diapered.
Menstruation pads also ran out, so nurses purchased more. “I bought my own thermometer, towel, everything for the patients,” Lunanithikul says. One diabetic patient lost her medication, so “I gave her mine.”
She also played host to doctors and nurses who had come to Phuket from afar. That meant buying dinners — lots of them. She plucks a restaurant receipt from her purse, totaling 6,200 baht. That’s about $105, an exorbitant amount of money for food in Thailand. But that’s Thai hospitality.
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.