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MANAGEMENT: TSUNAMI EVALUATION
Management of hospitals in
Aceh during the tsunami
DR HERMANSYUR KARTOWISASTRO
CHAIRMAN OF THE INTERNATIONAL AFFAIRS DEPARTMENT, INDONESIAN HOSPITAL ASSOCIATION
Abstract
On December 26th, 2004, Aceh and its vicinity was hit by two natural forces consecutively, an earthquake and a
tsunami. Hundreds of thousands of people perished, leaving the remaining of about the same number to become
refugees. The writer was assigned by the Ministry of Health to Aceh on duty on the second and third week after the
catastrophe, to help the management of Zainoel Abidin General Hospital in Banda Aceh, the province’s biggest
hospital, revive its operation.
The hospital once had 400 beds with 911 employees
and 61 doctors, not to mention the facilities of CT
Scan, operating microscope and others. Besides giving
health services for the local people, the hospital also stood
as an educational hospital for Syiah Kuala University Medical
School’s students.
Besides the writer, the other members of the hospital’s
reviving team were two senior nurses (nursing managers),
one engineer and one administration clerk. When I left
Jakarta, I had already in mind the approach of man, money,
material and method that I was going to apply there,
however, the real condition in the field was totally different
from what I had pictured.
The healthcare activities for in-patients and out-patients
were only given in the emergency unit, and conducted by
the Jakarta province’s health team. When I assessed the
management on 8 January, 2005 (two weeks after the
tsunami), I came up with conclusion:
➜ Manpower: Only six out of 911 staff came to work that
day. They were: the director, one department head, one
technical officer, 1 administration clerk dan one lab
staff. Since the lab was closed, the staff was assigned to
cater foods for hundreds of volunteers.
➜ Money: The hospital’s director did not have a fixed
source of income to run its daily operation. And there
were hundreds of volunteers who worked hard to clean
mud in the vicinity who needed to be fed. Not to
mention the needs for diesel gasoline to run the
generator (The country’s electricity company was not
operating at that time), etc.
➜ Material: All the hospital’s areas were inundated with
mud. The height could reached upto one metre in
several areas, meaning, all the beds, cupboards, tables,
chairs and medical equipments were submerged in
mud. All rooms had to be cleaned and disinfected, as
well as all the equipment. We decided to dispose of all
wooden equipments that had been submerged in mud
and sort the metal equipments according to their
conditions (still functioning or not).
➜ Method: All the systems and operations was practically
shut down since all the equipments were broken and
there was no manpower. No financial management,
accounting, administration, documentary, management
information system, medical records, etc, was going on
at that time. Basically, the only activity running at that
time was a cleaning up operation to sanitize the
hospital and emergency unit.
On 8 January, 2005, 20 patients were treated in the
emergency unit. They were suffering from: tetanus, 12
people (60%), aspiration pneumonia and malnutrition, each
two people (10%) and stroke, fracture, enterithys, heart
failure, each 12 people (5%).
After conducting a managerial assessment, the decision to
have a daily coordination meeting at 9 am among all the
parties working in the hospital (locals and foreigners) was
taken. The forum would be the place to discuss all the
problems concerning the hospital’s operations, from
management, case handling to security issues.
The mud cleaning effort continuously took place.
Gradually, medical operations began to start as several
rooms were already clean. It started with turning the former
ICU into an adult treatment ward. Children and cardiology
wards were transformed into some kind of a small hospital
by the Australian and New Zealand armies. Progress
continued with the opening of the infection ward in the
Kulu Room. The consideration to use the Kulu room,
Vol. 41 No. 3 | World Hospitals and Health Services | 19