One Surgeon's Story - Banda Aceh
BY ROB ATKINSON

‘Did the earth move for you too dear?’ and the answer was, ‘Sure did’. In fact we have mandhis and squats for our ablutions, which is a small reservoir of water, and we had our own tsunamis racing around these. I wondered whether bricks penetrated mozzie nets or bounced off, and was pleased not to find out. Life progressed; and in my room, sleeping with three chainsaws, one of which was an extra big chainsaw, penetrating even earplugs and compressed pillows, this was not me.

The surgery was mostly large soft tissue wounds, quite purulent, requiring extensive debridement, drainage and then suture with grafting. We meshed the grafts manually, used pulsatile lavage, which is no substitute for sharp dissection, and Peter Riddell in fact used it with a certain amount of grinding of teeth on occasions. We had Gentamicin polymythcalate cement to build external fixaturs, but this was the best cement, donated by companies, including Gentamicin as used for joint replacement surgery. We made japates and kabanas in shape and placed them in the wounds, obeying the principle of exchange arthroplasty, and it was very hard to tell whether they made any significant difference but they certainly delivered a high dose of antibiotic into contaminated wounds. In the end we were able to skin graft and see the results of our early skin grafts. I was even allowed to do a few skin grafts myself, and treated fractures as well as making splints to control limbs that had debridement and skin graft.

We forgot a plaster saw, my fault entirely, but by using a rechargeable drill with postage stamp technique and a tenon saw with a guard, we were able to split plasters. I do not need to dwell on the disaster, all are well informed by the media, but the sight and smell was something else. I managed to visit our Army Field Hospital, who were enormously challenged with the most difficult task of cleaning up the general hospital which had been swamped by the wave. Mud throughout everything, body parts in the drains—it was not easy for them.
Peter Riddell and Frank Bridgewater managed to get to the Indonesian Army Hospital and did good work there, and finally Roger Capps and I left early because of the opportunity and the fact that the main team was going home via Jakarta to spend some time debriefing. Pressure of circumstances at home enabled me to hit the ground running on the Tuesday night, to try and pick up the pieces of normal civilian surgical life with hundreds of emails, paperwork, etc waiting.

The precipitant nature of this mission meant that a lot of people’s activities were on hold, with patients understandably transferring to other surgeons because of their commitments and lives moving forward. In essence I relearned some lessons. First, time lost in planning is never wasted and our team was the first one fully resourced and configured to deal with the pathology which was found. We did not run out of equipment and managed to resource food, water and equipment and drugs etc to many other people. Some of the teams, not to Banda Aceh I might say, seemed to fly in and fly out and the initial few days were very ad hoc. Thus my relearned lesson is one from the First World War: that Generals who do not walk the ground and get mud on their boots will make mistakes. The lack of data for us made life difficult and it was really CNN that demonstrated to us what we were likely to see. This proved to be so. The final lesson was one I had noticed before in Africa, which is the fly sign. If you are lying on your mat on the floor with four flies on you, you are probably doing very well. If you have forty flies I suspect there is a problem. More than that, the prognosis becomes worse. Flies know things!

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One Surgeon's Story
- Bandah Aceh

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