In the Throes of Devastation

Wanting to do more for the Asian tsunami victims than donate money, nurse Jeanie Schmidt spent three weeks in Indonesia providing medical services to survivors. She shares her experience with NWM.

When Jeanie Schmidt, RN, BSN, departed for Banda Aceh in January, she had no idea what to expect. Given 48 hours departure notice and armed with only her passport and the bare essentials, Schmidt joined about 30 other American nurses on a journey to provide desperately needed medical assistance to the tsunami-stricken region.

Schmidt's three weeks in Indonesia was, for her, an experience like no other. As part of the International Medical Corps (www.imcworldwide.org), she tended to wounded locals in conditions that were, at best, sub-standard. She worked with practitioners from across the globe and managed to provide care with very limited supplies. Though the chaos of the experience stays with her, she says her time spent in Banda Aceh was extremely moving and worthwhile.

"I could never sustain the losses they have, and be continuously wonderful to strangers," says Schmidt, who is employed at Kaiser Permanente Santa Clara. "Everyone has lost someone, or many. They are all such wonderful, beautiful people to us, and to each other. It makes me happy to be of help to them."

Below is an account of Schmidt's time in Banda Aceh, as told by Schmidt to her friends in an email.

Hi everyone,

I don't like to send mass email, but I always like to receive it to know what's new with my friends. So, with that in mind, I thought I'd just send out what I keep writing over and over about my experience in Banda Aceh. Thank you so much for all your kind, supportive emails and all your thoughts and prayers.

I didn't have any email communication while I was in Banda Aceh. It was a stress to even borrow a cell phone briefly and try to call [husband] Todd once in a while. Tim Smith, the communications guy for International Medical Corps (IMC), came after about a week and had to use a media center in Banda Aceh late at night, and even that was not always reliable for getting communication out. We did a group email to be sent out by one person, but all the computers at the media center went down due to weather (lightning I guess) so it didn't get out until several days later. They set up a satellite phone one day that died after only five in the group got to use it. We were not able to get out much other than work, and especially not after dark. Eventually we got brave and learned there was a phone system called a Wartel a bit of a walk from the house. Despite all this, I still managed to rack up some big bills for rare short calls home.

I started working in the university hospital that was shown on CNN (Zainal Abidin Hospital in central Banda Aceh) where they were just shoveling the mud out. It was one of two hospitals left standing in the whole province, I think. It was hard to get started working-you had to go in and affiliate with someone who already had something set up, like this hospital for example. We had to attend their meetings and go back for three days in a row before we could get 'in' and start working in the ER. It was great to work with doctors and nurses from all over the world, but challenging with everyone bringing in their own meds/supplies and speaking different languages. I noted meds from six different countries in that ER. None of it familiar, and none of it able to be looked up; our U.S. references are for U.S. drugs. My Epocrates program on my Palm Pilot was invaluable to all of us for looking up drugs/doses for patients since we didn't have other resources except what we brought.

It was a dilemma to continue a plan of care or figure out what had been done for patients. We had scraps of paper, at best, for charts, and certainly not everyone spoke or wrote English. The world was there; we had groups in the ER from Switzerland, China, Korea, Indonesia, Belgium and Spain, not to mention the Australian and German armies working to get the water and sewer back up, as well as setting up their own ORs, labs and x-ray facilities on the grounds.

Unfortunately, the American doctor put 'in charge' of our little IMC group efforts, and thus the American efforts in the ER, was the epitome of the arrogant American. He and another nurse with little experience would stand back and criticize all the other practitioners instead of just rolling up their sleeves and helping out. Each day (in our meetings) he would rave about who (which country) he was going to 'kick out' of the ER. I think these two forgot the mission and really needed some multicultural counseling (thankfully, we eventually rotated in a few other excellent American docs).

The environment was harsh and filthy, with no water or toilets available. There were no bedpans and we made urinals out of water bottles. We had no way to clean up the patients. The mosquitoes and the flies were rampant. Cats were everywhere, including eating mice in the ER. (I felt so bad for all the many starving, emaciated animals roaming the streets.) It was hotter than Hades with no ventilation and high heat and humidity. We had to leave our shoes outside, so we were forced to work barefoot or in socks until we could come up with 'indoor shoes.' This left us slopping around in whatever mud, blood, sewage or excrement was on the floor. They did their best to mop, but chaos was constant.

We had limited equipment, supplies and medication, and about 200 patients a day. It was hard to do much to really treat patients. Sort of like arriving on the scene of a horrible car accident without an ambulance. There was a MASSIVE overabundance of doctors and few nurses. Which you'd think would be fine since docs can do, in theory, some of what nurses do, no problem. Unfortunately, in reality, it meant a small, crowded room full of doctors shuffling about, conversing and snapping photos, but doing little patient care (only a few docs were doing the bulk of the work). In a situation like this it would have been imperative for doctors to carry out some of their own orders instead of yelling 'nurse!' Amazing many did not ever catch on to that.

I truly enjoyed working with every medical team from the other countries, no matter what our differences in technique were. We could all learn from each other, with the exception of a couple ugly Americans. The flip side of everyone being there was that with over 100 NGOs, everyone wanted their territory. One Canadian nurse put it best, it was like a medical Olympics with everyone trying to outdo the other, which was absurd under the conditions.

We had so many cameras in our faces constantly, and with no permission from the Acehean patients. I was actually pushed out of someone's shot while caring for a patient. The doctors and the media were equally snapping shots and videoing. Maybe privacy is not an issue in other parts of the world, but it was hard on these people. We did not have control since it was not our ER. There were no curtains or barriers for privacy. It was a chaotic frenzy.

Since I wanted to help the community and not just see the inside of the ER, I asked to go out on a mobile clinic. Unfortunately, the day I was to start mobile clinic service was the first day of a five-day religious holiday for the Indonesians that we had no idea was to occur (a good thing for their healing, though). This meant no drivers, food, etc. (Thank goodness I had Granola bars and beef jerky.) Mobile clinics were also on hold. This setback was only one of many. The only thing you could count on throughout this experience was that you couldn't count on anything.

As an alternate experience, I moved on to the Danish Emergency Mobile Hospital (DEMH) for my last week. The Danish are amazing! They took us in with no qualms or hesitation. There is a write up about this hospital on the IMC Web site (www.imcworldwide.org). It was such a pleasure to work with the creator of this hospital and every person on their mission. I helped in OR and worked PACU with local medical students. They told me I was in charge there, but that was an overstatement. These students had it all under control and could have taught the seasoned doctors back at that ER a few things. I recovered patients and the standard of care was nearly up to home but with less monitoring capacity. Relying on skills and instinct was key. The tents were still hot, but animals were kept out, there were fewer insects and it was far cleaner. They actually had air conditioning that maybe brought down the temp four degrees! The OR was the coolest place to be. Unfortunately, we had to have a fly- and mosquito-swatting match at the beginning of each day-the insects came into the OR with each patient.

The Danish even brought their own cook and fed us daily. It was so good to have something besides white rice and eggs. They gave us each a much-coveted DEMH t-shirt, almost literally off their backs, and invited us for a special dinner two nights in a row. We were also given our own set of clogs to wear inside the tents. The Japanese ran the ER/clinic area at the DEMH (until Mentor took it on) and brought sparkling non-alcoholic juice for dinner. What a treat in a part of Indonesia where alcohol is prohibited.

The Acehean people are so lovely, kind, appreciative and wonderful. Unfortunately, the common thread of all experiences and encounters there was that everyone had lost someone, everyone and everything they knew or owned. It was not uncommon to hear of entire families of 12 or more being wiped out. Any mild suffering on our part was so worth any effort to help these people. But I must admit, it was a very long three weeks.

I didn't anticipate the adjustment of coming home. The first night back, sitting on the couch with my husband, I was still smelling rotting flesh. I haven't been able to adjust my sleep (jet lag, nights and days reversed, and I'm still dreaming of all the people and devastation). I wake up thinking they are all around. I never expected any of this. I actually cried missing them on the plane ride home. It is hard to go back to creature comforts knowing they are all left forever among the devastation.

I also didn't expect the anger from co-workers I received from them having to cover my shifts and not understanding I had only 48 hours notice to get ready to leave for Indonesia and go. Most of my co-workers were very supportive. The positive definitely outweighs the negative, and such is life and nursing. I met a native Sri Lankan man on the plane who actually managed to take over $2,700 from his U.S. Masonic Lodge and start an orphanage in Sri Lanka. It has been such a blessing to be near so many wonderful, caring people. I had so many wonderful experiences, I could go on for days (with the length of this, apparently I already have).

I hope everyone is well. Take good care.

Love, Jeanie

Nurses World Magazine salutes Jeanie Schmidt, the International Medical Corps and the many thousands of brave outreach workers who continue to respond to the catastrophe in Southeast Asia.