Clinician contributions Critical Care Emergency

1. Disaster Relief – Dr Mark Little

Mark Little
Written by Mark Little

The RAAF Hercules slowly turned for a final approach and through the small window we got our first view of the city of Tacloban. Five days beforehand Typhoon Haiyan with wind speeds of greater than 300kph winds had crossed the coast almost over the top of Tacloban. Tacloban, a city slightly bigger than my home city of Cairns, lay in ruins. All we could see was rubble, and what I imagined Armageddon would look like.

As an emergency physician, I was the clinical lead of a 37 person Australian Medical Assistance Team (AusMAT) deployed on behalf of the Australian Government in response to the typhoon. Many health professionals from around Australia have trained and deployed on previous missions, to locations such as Indonesia, Christchurch, Samoa, & Pakistan as well as responding to crises within Australia. I had been contacted about 36 hours earlier and within a few hours was on my way to Darwin to meet other team members. This time we were taking 28 tons of equipment and establishing a tented field hospital with a surgical capability.

Walking of the Hercules, you immediately noticed the heat and humidity (not unlike Darwin weather in November), but coming from the tropics it was not too overbearing. Then you saw the thousands of locals lining up in the sun trying to get out, the completely destroyed airport, the lack of trees and buildings. Because, as well as the wind, this city was hit with a 3 – 4 m storm surge.

We established our hospital across the road from the airport, and became one of the major surgical referral facilities. The days were long, often greater than 16 hours. We slept on stretchers in large tents, and ate dehydrated camping food. We brought our own food, water, power, toilets, showers and were totally self sufficient. A second AusMAT team arrived 2 weeks later to take over and continue on the work of the first team.

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Our ED received ~ 2800 patients in the next 4 weeks, many with terrible fractures, spinal injuries, tetanus, and infected wounds, as well as usual health issues, and exacerbations of chronic health conditions such as airways disease and diabetes. Our theatre team (2 surgeons, 2 anaesthetists and nursing team of 4) performed nearly 240 procedures, running often late into the night. We had one tent with 2 operating tables. Our staff ran an inpatient facility with 37 beds, and admitted hundreds of cases, often caring for their families as well as the patients. Our pharmacist monitored and sourced our medications, and our logistics team of six (firefighters usually), helped set up and run the facility. We liaised closely with Philippino organisations like the Ministry of Health and Philippine Defence Force. Philippino health professionals (such as doctors, nurses, ambulance teams, social workers) worked with us to provide the care that was needed.

But it is our Philippino patients we will never forget. Patients with fractured femurs, and other major orthopaedic injuries were presenting 2 – 3 weeks after the storm. The young boy who lost part of his leg when it was hit by flying metal at the height of the storm. The young girl hit with a piece of wood that lodged into her skull.

Everyone had lost someone. A man in his late 30’s had a nasty foot wound that required a few trips to theatre for debridement. He and his wife survived, they lost their home and their three children were washed away by the typhoon. The local catholic priest who joined us and cared for all, lost his home a spent a few terrifying hours clinging to a roof with a nephew as the storm surge rose around him. The lady with the terrible head wound who with her family clung to a palm tree during the storm, until the tree fell and killed her husband. The older lady who dog paddled for 3 hours in the storm surge watching others drown. We also had to confront deaths in our hospital, the young man who dies of tetanus, the elderly lady with a cardiac condition, and the baby of a young woman who presented in obstructed prolonged labour that could not be resuscitated once born. Nine would die in our hospital.

But there were so many that we did help, and many lives were saved. Sick children with pneumonia would go home a few days later, elderly patients septic from wounds would improve with debridement and antibiotics, patients in pain from fractured limbs would be smiling a day later with fractures realigned and the limbs casted.

I have deployed on a number of AusMAT missions. This was the hardest deployment I have done, and probably the one with the greatest health impact. But I will never forget the people of Tacloban and the Philippines.

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Photography by Dr Mark Little

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Mark Little

Mark Little

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