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Chaotic hospitals battle to save injured

Hospitals in Indonesia's Aceh province are seeing a second wave of  tsunami victims, mainly with fractures and breathing problems related to chest injuries or having swallowed mud. Some have wounds that have spawned dangerous infections.
/ Source: a href="" linktype="External" resizable="true" status="true" scrollbars="true">The Washington Post</a

Adrian Syah, a government worker, survived the tsunami 11 days ago by clinging to a log in the waves, despite being pummeled by rocks and wood debris. He paddled to safety along Aceh's battered west coast and reached an isolated refugee camp on Sumatra island, hoping to receive treatment for a gash in his arm that he suffered in the ordeal.

He waited for 10 days. A U.S. Navy Seahawk helicopter finally airlifted him to the military hospital in Banda Aceh, the provincial capital, on Tuesday afternoon.

"I was worried because my wound was really bad and it was very painful," Syah, 32, recalled on Wednesday, blinking frequently and wiping his dark, bloodshot eyes.

Relief workers are moving quickly to reach people such as Syah, some of whom have easily treatable maladies that are threatening to escalate into far more dangerous conditions, such as gangrene and deadly infections. Tens of thousands of Acehnese are stranded on the western end of Sumatra island, but the Indonesian military hospital is one of only two functioning hospitals that can receive them in Banda Aceh. The hospitals are overflowing with the wounded, sick and homeless. Doctors vow they can make room when necessary, but teeming wards and backlogged operating tables have restricted their efforts.

Syah lay on one of about 100 green stretchers, shoehorned between 150 regular metal beds to accommodate the crush of victims. A bandage was wrapped around the oozing wound in his badly swollen arm, and an intravenous drip was inserted into his other hand.

'All in the same boat'
"I can understand the conditions," said Syah, a curly haired man with jug ears and a furrowed brow. "We're all in the same boat."

Almost 250 patients were packed into the military hospital, according to Sahat Edison Sitorus, a physician who had come from southern Sumatra to coordinate medical services. He said the hospital was receiving about 80 patients a day from Banda Aceh and outlying provinces. Doctors said all of the patients are being seen, but not all are allowed to remain at the facility.

The majority of the people most seriously injured in the tsunami have long since died, doctors say. But the hospitals are seeing a second wave of victims, mainly with fractures and breathing problems related to chest injuries or having swallowed mud. Some have wounds that have spawned dangerous infections.

Carol Bellamy, director of UNICEF and Lee Jong Wook, director general of the World Health Organization, toured the crowded hospitals in Banda Aceh on Wednesday. They expressed concern about gangrenous wounds forcing surgeons to amputate limbs, and scores of children with diarrhea.

In the steamy hospital wards, nearly any free space on the white tile floors has been taken by the army stretchers. Bandaged arms and legs protrude from under light sheets and sarongs. Friends and relatives crouch beside some patients, fanning them with envelopes, towels and bits of cardboard, and shooing away the flies. Patients without visitors try to muster enough strength to fan themselves.

'Share their sadness'
Sitorus, 52, a neurologist with tired eyes behind silver-rimmed glasses halfway down his nose, said part of the challenge was convincing patients to leave after they've been treated.

"We urge them to be discharged but many are homeless and have no relatives left," he said. "They don't know where to go. This is a place for them to share their sadness with others."

Doctors said the hospital was jammed, but far less chaotic than it was in the days immediately after the tsunami. The corridors are mopped of the sludge and blood that once slicked the floors. The stench of decomposing bodies has dissipated.

To address overcrowding in the wards, Sitorus said the hospital staff was preparing to shift some patients to the hallways.

That has already been done at the smaller Fakinah Hospital. Patients lay dozing Wednesday in the lobby and corridors dimly lit by weak fluorescent lights.

"If a patient comes in, we find a way to treat them," said James Branley, 41, an internist who is part of a 28-member Australian medical team at the hospital. "But we really don't have a lot more space. In the last two days, we've been putting people directly on the floor."

He said that so far, about 70 patients have been admitted to stay at the hospital, half of whom are on the floor. As many as 200 new patients a day have come seeking treatment , including some airlifted by U.S. helicopters from the west coast, Branley said.

About 15 patients, scheduled for evacuation to the major city of Medan in northern Sumatra, have been moved from the hallway to a shaded terrace facing the hospital's small garden. Plastic IV sacks hang from ropes strung above the terrace.

A third facility, the Zaenoel Abidin General Hospital, was damaged during the tsunami. The external wall of the three-story complex collapsed and the building is partly buried by mud and debris. Salvaged hospital beds, desks and other equipment have been stacked in the yard. On Wednesday, crews tried to dig out the entrance to the emergency room, shoveling sludge into wheelbarrows and hauling it away.

'She'll die today, I imagine'
Doctors said they were counting on U.S. and Australian military aircraft to transport patients who could not receive adequate care in Banda Aceh to Medan.

Sitorus said those included people with amputated limbs requiring prosthetics, fractured skulls and burns. He also wants those requiring surgery for broken bones to be evacuated because they risk serious infection if treated in the military hospital's overcrowded operating room.

At Fakinah Hospital, Branley said he was even lacking facilities for taking X-rays and doing laboratory work. Especially troublesome, he said, was the lack of an adequate intensive care unit.

Dressed in jeans with a stethoscope dangling in front of his red shirt, Branley walked to the doorway of a crowded ward. He raised his right hand, tucked in a blue rubber glove, and pointed to an old woman either sleeping or unconscious on a bed in the corner. He said that the infection from a wound had spread throughout her body and Fakinah Hospital did not have the intensive care facilities to stem it.

There was no reason to try airlifting her to Medan, Branley said.

"She'll die today, I imagine," he added. "She's too far gone at this stage."