The State of the Federated States
MDs in the Wake of Typhoon Chata'an
Medical Volunteers Pitched In Despite The Lack of Supplies And Medicine
The news about approaching Tropical Storm Chata‘an caught Ayuda Foundation Executive Director Carlotta Leon Guerrero’s attention.
“I know Chuuk is not prepared for any kind of high winds,” she says. “Two days later they called and said there were 10 deaths, and then the next day it was 12 deaths.”
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The death toll eventually rose to 47.
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The Ayuda Foundation (ayuda is the Spanish and Chamorro word for help) was started on Guam in 1995 by then-Senator Carlotta Leon Guerrero, Dr. Michael Cruz and Continental Micronesia. They wanted the organization to improve access to health care for Islanders.
Grasping the seriousness of the storm situation on Chuuk, Guerrero first contacted the commander of Guam Naval Hospital. “When you really need a whole lot of something medical, Naval Hospital is the one,” she says.
Meanwhile Chata‘an hit Guam on Friday, July 5, three days after the Chuuk devastation. On Saturday, Leon Guerrero and Cruz assembled a team of five medical volunteers and gathered donations of much-needed supplies. “We were able to put together about 26 boxes of medical equipment and supplies as well as a bunch of boxes of medicine from Naval Hospital.”
One day after the supplies left on July 7, Continental Micronesia carried the team of Cruz, a surgeon; Lt. Commander Brent Thiel, a Navy orthopedic surgeon; Petty Officer Felipe Rios, an orthopedic technician; Commander Robert Hunter, a family practice physician; and Jennifer Rosario, head nurse in Guam Memorial Hospital’s surgical unit. The group reported to the Chuuk hospital in Weno, to assist the overwhelmed staff.
In the best of times, medical services on Chuuk are plagued by shortages of medicine and equipment. So without proper care, lacerations, punctures and abrasions had become infected by the time the Navy and Ayuda personnel arrived. “When we got there, we must have spent 10 or 12 hours just cleaning out wound after wound,” says Rosario. Though the team arrived a week after the storm, many wounds still contained gravel and soil. “We had one gentleman with a grossly infected thumb that we had to take off,” says Thiel. “Another we had to amputate below his knee because his wounds were so infected. There was nothing we could do to save his limb.”
The X-ray machine at the Weno hospital had not been working even before the storm. Without a working X-ray machine, the doctors diagnosed fractures by symptoms alone. One broken hip was undiagnosed until the patient was medivaced to Guam a month later. In order to put a patient into traction, Thiel went to a hardware store and “got some pulleys and rope and stuff like that,” according to Rosario.
One of the more tragic episodes involved a boy with an open skull fracture, and extremely severe lacerations to his armpit area and leg. For three days, the surgeons operated on the boy for several hours each day. On the fourth day, the boy died.
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“To see an 11-year-old, healthy kid go through something like that has a profound and lasting effect,” says Thiel. “And then to realize that if he wasn’t in that setting, he probably wouldn’t have died.”
Hunter had the additional task of making recommendations to FEMA and the Naval Hospital. Much of his information was gathered through contact with the Air Force Civic Action Team (CAT) stationed in Chuuk and missionary Terry Colson. Lt. Stephen Clark, a visiting Navy physician connected with CAT, and Master Sergeant Dale Kirby, the CAT medical corpsman, traveled to Tonoa island, the site of much of the devastation.
Dr. Mark Keim of the Centers for Disease Control and Prevention arrived in Chuuk July 15. (His comments here are his own and do not represent the CDC.)
“Many victims with serious injuries remained untreated in their villages,” he says. “Most with traumatic injuries now worsened by secondary wound infections, unsplinted broken bones, as well as lack of basic shelter, food and sanitation.”
Though tasked with providing technical assistance only, he and other U.S. medical personnel traveled from island to island in the lagoon, providing medical care on their own time. For several days he did not even have a stethoscope.
On July 21, Ayuda volunteer nurses Rose Perez of the Guam Nursing Center and Rhonda Green with Baptists in Mission flew to Chuuk via Continental Micronesia after having been unable to land two days earlier on a stomach-churning C-130 flight. Perez dressed about 16 wounds daily. She lamented the lack of pain medicine.
After they were on the ground, she says, they found that “some of the victims’ wounds were so deep that normally, if you touched a wound like that, the patient would be screaming. But during the dressing, they just closed their eyes and let you work on them.” The local nurses were so accustomed to shortages that when Perez suggested they change gloves after every patient, they responded that the gloves would run out.
“They had to take nonsterile gauze and put it in the sterilizer so we could use it,” says Green.
Without sufficient government support, the Weno hospital could not provide adequate service even before the storm, so NGOs like Ayuda, military volunteers and religious organizations have had to take up the slack. In many ways, healthcare on Chuuk was already in crisis when the winds of Chata‘an blew in, exposing the crisis for all to see.
