Teeming wards and operating tables restrict medical efforts

INDONESIA:  Alan Sipress found Sumatra's hospitals overflowing with sick, wounded and homeless who wished to share their sadness…

INDONESIA: Alan Sipress found Sumatra's hospitals overflowing with sick, wounded and homeless who wished to share their sadness.

Adrian Syah, a government worker, survived the tsunami by clinging to a log in the waves, pummelled by rocks and wood debris. He paddled to safety along Aceh's battered west coast, and reached an isolated Sumatra refugee camp, hoping to receive treatment for a gash in his arm.

But he waited for 10 days. A US Navy Seahawk helicopter this week airlifted him to the military hospital in Banda Aceh.

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

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Relief workers are moving quickly to reach tens of thousands of stranded Acehnese on the western end of Sumatra island, but the military hospital is one of two functioning units that can receive them in Banda Aceh. The hospitals are overflowing with the wounded, sick and homeless. Doctors make room when necessary, but teeming wards and backlogged operating tables have restricted their medical efforts.

Mr 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. An intravenous drip was inserted.

"I can understand the conditions," Mr Syah said. "We're all in the same boat."

Almost 250 patients were packed into the military hospital, according to Dr Sahat Edison Sitorus, who had come from the south of Indonesia's Sumatra island to co-ordinate medical services. He said the hospital was receiving about 80 new patients a day from Banda Aceh and outlying provinces.

The majority of those most seriously injured in the tsunami have long since died, doctors reported. But the hospitals are now seeing a second wave of victims, mainly with fractures, breathing problems related to chest injuries or having swallowed mud. Some have infected wounds.

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 protruded from under light sheets and sarongs. Friends and relatives crouched beside some patients, fanning them with envelopes, towels and bits of cardboard and shooing away the flies.

Patients without visitors tried to muster enough strength to fan themselves.

Dr Sitorus (52), a neurologist with tired eyes behind silver-rim glasses halfway down his nose, said part of the challenge is convincing patients to leave after their treatment.

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

Though jammed, doctors said the hospital is far less chaotic than its was in the days after the tsunami. The corridors are now mopped of the sludge and blood that once slicked the floors. The stench of decomposing bodies is no longer present.

To address overcrowding in the wards, Dr 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 in the lobby and corridors, lit by weak fluorescent lights.

"If a patient comes in, we find a way to treat them," said Dr 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 about 70 patients had been admitted. As many as 200 new patients a day have been arriving at the hospital, including some airlifted by US helicopters from the west coast, Dr Branley said.

About 15 patients, scheduled for eventual 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 Zainil Abidin hospital, was damaged during the tsunami. The external wall of the three-storey 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.

Doctors said they are now counting on US and Australian military aircraft to transport patients to Medan who cannot receive adequate care in Banda Aceh.

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

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

Dressed in jeans with a stethoscope dangling in front of his red shirt, Dr 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, Dr Branley said.

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