World Hospitals and Health Services - International Hospital ...

MANAGEMENT: TSUNAMI EVALUATION
The numbers of patients that
exceeded hospitals’ capacity,
the many computers that were
broken after they had been
immersed in the water and the
lack of medical record staff
were among causes of the
problems
“
”
were found by volunteers who then took them to the
hospitals for further care. The others came with their family,
not only because they wanted to be with each other, but
they no longer had a place to stay and turned the hospital
into their new home. To cater for all the food for the
patients, as well as their family, the hospitals were equipped
with a public kitchen. Here, the hospital’s responsibility was
not only to care for the patients, but for their family as well.
This is a heavy duty since the number of local paramedics
was still very limited.
When the patients were healed, the families were often
confused where to bring them since their home had turned
into ground zero. International Red Cross opened a field
hospital in Banda Aceh Stadium area that could also
function as temporary shelters for hospital discharged
patients without complete recovery.
So other patients with more severe injuries and in need for
more intensive care could take their places in the hospital.
The more disheartening situation applied for patients that
passed away in the hospital. Usually the deceased body were
given to the family who then would take care for the burial
process. However, that was not always the case here in Aceh,
especially if the deceased no longer had a house or family. In
many cases, it was also difficult to find a piece of land for the
burial to take place.
At the end, not only the in-patients that the hospital have
to take care, but also their family and the discharged
patients, the healing ones and the deceased ones. This is
additional work that is not included in our hospitals’ scope
of work.
With improper shelter, inadequate food and trauma as
well as stress, the refugees’ body resistance had weakened
with time. Nutritious food feeding, along with suitable stress
and trauma management programmes are the best option to
solve this problem.
Facilities
Another problem that needed to be dealt with is the
destruction of health facilities, hospitals and public health
centres. Our experience showed that despite hundreds of
volunteers who had worked full time for up to two weeks
after the catastrophe, the Zainoel Abidin Hospital was still
not fully cleaned although several rooms could already be
used.
Several hospitals lost all their archives, including all the
records and status that they use to write patients’ medical
development. Because of this, hospitals used blank papers
as its replacement to write patients’ medical status and were
not filed orderly as in other hospitals. However, the archives
problem would not stop all the paramedics to give their best
services.
Medical record system also had not functioned at its full
capacity yet due to some problems in the data entry process.
The numbers of patients that exceeded hospitals’ capacity,
the many computers that were broken after had been
immersed in the water and the lack of medical record staff
were among cause of the problems.
The hospital environment was also surrounded by waste
management problem. Every activity in the hospital would
generate a variety of waste. Some solid wastes were
processed in the incinerator (by burning them), while the
remaining were dumped in a localized waste ground to be
picked up by the city sanitation service. At the moment, the
waste is not processed as it should be, creating stacks of
waste in the hospital area.
Another sanitation problem was also created by mud. The
cleaning process had reached only the rooms and the
buildings of hospitals, the drainage channels were still
untouched. As a result, water often inundated the hospitals’
yards, especially since the city drainage system itself was still
clogged with mud and woods from tsunami.
With all the hospitals and public health centres destroyed,
majority of medical equipment were lost or broken. Two to
three weeks after the tsunami for example, medical
equipments were mounting high in Zainoel Abidin
Hospital’s yard. Part of the equipment such as wooden beds,
racks and cupboards could be cleaned and used again, while
the others, such as high technology medical equipment, had
to be checked first. Many countries offered to donate
medical equipment. Good coordination is needed in order
to get the best result out of the donation. To maximize the
healthcare rehabilitation process, it is best to evaluate the
form of future healthcare service in Aceh from now.
Conclusion
There are five basic steps that can be done to revive
hospital services in Aceh. First, there is a need to map the
condition of all hospitals in the disaster areas. It is best to
conduct the mapping with the management system
approach of Manpower, Money, Material and Method.
Second, the system of hospital services should be
designated, which disaster area does each hospital have to
serve. It is possible that the area specification will change
after the catastrophe. City centre might move to another
area, so, the hospital location has to be readjusted
accordingly or a change in population that makes the
hospitals have to downsize or upsize its capacity. The act
of downsizing, relocating or determining hospital
22 | World Hospitals and Health Services | Vol. 41 No. 3