Assalamualaikum, and a very good -whatevertimeofthedayitis -to all of you ppl.  

It’s 4.12 a.m. now, and I just felt like I cannot abstain anymore from writing despite a halfhearted attempt to do so, with the justification of exams around the corner. I’m going to continue with Extreme Medicine, insyaAllah. Continuing with the technical aspects of response to disaster, as presented by Dr Burhanuddin and Dr Latiff. (for proper titles and credentials, u can refer the website i pasted in the earlier episode, if u r really keen to get that.)

The actions involved in extreme medicine can be fashionably (I wonder if this is the appropriate term to use..)  summed up as 6R’s. Ready, Retrieve (rapid response, reach), Resuscitate, Repair, Rehabilitate, and Return.

Self-explanatorily, READY means that the extreme medicine team is always ready and poised to spring into action, whenever disaster strikes. This implies a state of preparedness in various aspects. Adequate and balanced team members, equipment, financial, and political acceptance (not getting into trouble with government, any government, is a VERY IMPORTANT criteria of any medical relief groups, I presume) are among the significant elements. So, whenever a calamity occurs, which seems to be a daily occasion nowadays, the team can get all of its resources together and launch into the second stage - RETRIEVE (rapid response, reach). Aha, Mercy Malaysia and Medecins Sans Frontieres (MSF) are among the medical relief groups that first arrive in the tsunami-stricken Acheh coasts. But the on-site stories will have to wait, I’m expounding on technicalities here.

RETRIEVE (rapid response, reach) refers to the action of responding rapidly to disaster and reaching the victims to retrieve them and bring them to safety. Pretty much summed up in a sentence isn’t it? Rapid response here means quick action - relief teams don’t sit with mouths agape at the scene of disaster or wander around aimlessly thinking of what to do while hundreds and thousands are dying. All actions have to be immediate - cleaning up muddy hospital rooms, setting up clinic booths, building tents for survivors, seeing to their nutrition and sanitation, bringing survivors to safety, handling dead bodies, etc -. All resources must be utilized to the most while adapting to the situation, every action must be well-planned and systematic, which implies how important it is for teams to be READY in the first place.

One significant issue to be addressed here is that of leadership and synergy. Dr Latiff gave an account of his experience in Acheh, when a LOT of help is offered. Medical relief teams poured in from all over the world. Individuals, experienced or not, able or disabled, came to chip in their bits. However, these multitude of goodwill would lack efficiency, even be disastrous, without proper leadership and synergy. Too many cooks spoil the broth, and this saying is true, even in extreme medicine when one would think that any help is welcome. There should be a leader whom everyone turns to for reference, a point for everyone to converge, so that there can be a common agreement of what everyone should do and where, not being scattered all over the place.

The next step is RESUSCITATE. In simple words, give the victims enough emergency support to save them from the initial distress. Get the bleeding stopped, the protruding broken bones firmly fixed in place, get the mud out of the bronchi and lungs of the almost-drowned victims, carry blood transfusion and fluid infusions to replace the amount lost, etc.

Then comes the fourth step, REPAIR. Again, simply put, after initial emergency support, now is the time to fix anything that needs fixing, but in a less urgent manner. A good example is operations done on injured patients to stitch up broken skin, to join broken bones together, to remove/repair damaged organs, etc. Not much to be explained here, but reiterating the fact that the resuscitation and repair steps have to be carried out in a very ‘primitive’ manner, as compared to the technological advancement in the medicine world today. Hospitals are devastated, clean water difficult to obtain, sterile medical equipments very scarce. A lot of times, relief teams had to work using re-used bandages - dirty bloody bandages normally thrown into refuse bags in hospitals and medical schools, cleaned and boiled in hot water before the tattered discoloured pieces of cloth are applied to another patient’s wounds. Boiled medical equipments are almost a norm.

One pathetic truth in these difficult situations is when doctors have to decide who deserves the resources and who had to be left dead. When Katrina ravages New Orleans, victims who were considered hopeless were left to die. Similar things happen in other disaster-stricken places of the world- Acheh, for instance, when the time comes for the medical team to decide that enough has been done for a particular patient and the limited resources would be better allotted to patients with greater chances of survival. No, it’s not playing God, it’s making the most use of what is available in times of ordeal. In the end it’s still God who decides lifes and deaths. And even so, the dying patients are usually given the best possible care that can be given, at least so that they can die in dignity.

A touching account from Dr Jemilah was about a woman, a tsunami victim in Acheh, who was so severely wounded with maggots coming out of her bodily orifices and even eating parts such as her lips. She was one of the hopeless ones, yet the doctors still helped her, by cleaning her wounds and removing the maggots. I can still recall the sentence Dr Jemilah said the woman managed to articulate before her dying hours, which brought tears to my eyes. Something like, “Sakit, bu, tapi saya tahu sakitnya tidak lama. Terima kasih.”

How can people bicker and fight each other in the smallest of issues when humanity is in dire need of genuine love, care, and help all the time?

Going to the fifth step, REHABILITATION. When the external injuries are repaired, ‘fixed’, there must be adjustments before the patients are allowed to go home. Disasters injured people not only physically, but also mentally and spiritually. The impact of a severe trauma is all-encompassing. Rehabilitation aims to restore the patient, as close as possible, to his/her condition prior to the trauma. To become an individual with autonomy and dignity, not traumatic, paranoid, and unable of self-respect. To become a significant part of his/her community again, not as a malfunctioning, isolated unit. To achieve this, rehabilitation must be carried out both physiologically and psychologically. Counselling is very important during relief work. Well, psychologists and psychiatrists are important personnels in a medical relief team, together with the surgeons, clinicians, and whatnots. People - even professionals involved in relief work - used to think that these ‘mental’ experts are less important, during the early days of relief work, but now as experiences pile on top of each other, their presence is largely recognized and needed.

Finally comes the much-awaited part - RETURN. Fully recovered, insyaAllah, or as close to complete recovery as possible, the patients are returned to their community. The community is an injured one, one affected by trauma, but hopefully one with dignity and will to live. For it is this self-respect and willpower that are the causes to sustain their survival through the tough post-traumatic life.

Erm, in my notes I found a not-very-explicable seventh R. REWARD. Perhaps this refers to the medical team itself.. =)

InsyaAllah I’ll come up again with a final (hopefully) episode of EXTREME MEDICINE, touching on the motivation, practicality, and spirituality behind relief medicine, as well as some on-site accounts.

Upholding love, protecting life, treating sores and healing souls. For humanity, in Allah’s name.

meow~