Australian Perioperative Nurses' Humanitarian Activities in Banda Aceh

Note from column coordinator Lois Hamlin:As I write, it is nearly 18 months since Patricia Seifert, RN, MSN, CNOR, CRNFA, FAAN, as the newly installed AORN Journal Editor-in-Chief, announced several initiatives aimed at building on and enhancing the AORN Journal.1One of these new opportunities was a column intended to broadly reflect the increasing global influence of perioperative nursing. The aim of the bimonthly Global Perspectives column, introduced in September 2008, was to “[capture] the rich diversity of our national and international colleagues' efforts as consultants, teachers, proponents of standards, and policy initiators that have an impact on global health care.”1(p16)This column, like other initiatives, reinforces the member-focused, forward-thinking approach of the AORN Journal. Cynthia Spry, RN, MA, MSN, CNOR, an independent clinical consultant and distinguished perioperative nurse with 30 years of experience, was the inaugural column editor. She has now stepped down from this role but not before establishing it in a most able fashion. Cynthia introduced AORN Journal readers to the International Federation of Perioperative Nurses, highlighted the experiences of perioperative nurses working overseas, and explored the concept and rise of medical tourism, to name but a few of her accomplishments. These were illuminating insights, and some resonated with me personally. I have moved from one country to another to live and work, and thus have experienced “culture shock,” albeit very mildly; at least I spoke the same language. I am honored and delighted to have been given the opportunity, as the new column coordinator, to build on the solid foundation created by Cynthia and, as an Australian, to bring another perspective to it. In our socially connected world in which we blog, Flickr®, and tweet; are LinkedIn®; check out MySpace™; post videos on YouTube™; and discover how many friends we have on Facebook®, where I live and work is somewhat inconsequential, anyway: six degrees of separation is a redundant notion. volunteer their services and unique skills during natural disasters and humanitarian crises and in war zones; have adapted their care to meet the unique cultural needs of the communities they serve; and deliver surgical care in unusual and novel circumstances. Likewise, I'd love to tell some of the stories of the recipients of our care from a “global perspective,” if I can find surgical patients to tell me their stories, although I do have a nebulous plan for this. I believe that you, like I, will be inspired and moved by some of the stories from the field that I hope to bring you. This includes, potentially, the humanitarian work of Mercy Ships operating off the coast of East Africa; the activities of Kate Woodhead, RGN, DMS, a UK perioperative nurse and former president of the International Federation of Perioperative Nurses, and Lesley Fudge, RGN, co-founders of Friends of African Nursing2and mobile surgical service delivery in remote areas of New Zealand. I hope that an early article in this column will be the experiences of a perioperative nurse fortunate enough to be offered the opportunity to work in the OR of the mobile field hospital situated in the athletes' village, Vancouver, Canada, during the Paralympic games. But I am getting a little ahead of myself. More importantly, I want to hear from you. I want to know what you would like to read about or perhaps help you publish your unique global experience. I can be contacted at[email protected]. That said, I would like to present my inaugural column, which highlights the overseas humanitarian work of some of my fellow Australian perioperative nurses. Australia, like the United States and many other countries, has a strong tradition of helping its neighbors in times of need, whether such need is predicated on humanitarian grounds, in response to terrorist attacks, or after natural disasters. One such large-scale, global event was the 2004 Indian Ocean tsunami. The actions of three Australian medical teams in Indonesia demonstrate the challenging situations that can be encountered in the aftermath of a natural disaster, as well as the teamwork and innovation that are required to help the victims of such disasters. The earthquake that generated the great Indian Ocean tsunami of 2004 is estimated to have released the energy of 23,000 Hiroshima-type atomic bombs, according to the US Geological Survey.3 By the end of the day on December 26, more than 150,000 people were dead or missing and millions more were homeless in 11 countries, which makes it perhaps the most destructive tsunami in history. In total, nearly 230,000 people were killed, tens of thousands more were injured, and 10 million became homeless or displaced. The epicenter of the 9.0 magnitude quake was under the Indian Ocean near the west coast of the Indonesian island of Sumatra.4 The province of Aceh was devastated, including its major city, Banda Aceh, and Indonesian losses were estimated at 130,736 killed with 37,000 missing3 and more than 500,000 displaced. There was an immediate response to the disaster from the international community; however, I am presenting the Australian efforts in Aceh, in particular in Banda Aceh, and the activities of three surgical teams that went there in the immediate aftermath. This is not meant in any way to diminish the efforts of other Australian teams deployed elsewhere or the non-Australian surgical teams, also active in Aceh, as well as the rest of Sumatra and other affected countries. The Australian Overseas Disaster Assistance Response Plan was activated by the Australian Agency for Overseas Development, and medical field teams from several Australian states were formed.5 They comprised civilian and Australian Defence Force, or military, reservists. The first two teams, Alpha and Bravo (all volunteers and from several states), were on the ground and undertaking surgery within 60 hours of the earthquake. They were totally self-sufficient and took all their own supplies, and, in the six days they spent in a small private orthopedic hospital commandeered by the Indonesian authorities for them and which had sustained minimal structural damage, they performed 108 procedures, mostly debridement of grossly infected wounds, and 17 amputations.6 After teams Alpha and Bravo returned to Australia, and 13 days after the tsunami struck, Team Echo, from the state of South Australia, arrived in Banda Aceh to continue the work. As a consequence of previous communication with the nursing leaders from Teams Alpha and Bravo and health department briefings, the members of Team Echo were tasked to be self-sufficient and independent for 14 days, without any logistical assistance.5 Team Echo had 23 members, including a team leader, four anesthetists, four surgeons from differing specialties, eight perioperative nurses, one infectious diseases physician, an emergency department physician and nurse, two intensive care unit paramedics, and a fireman-logistician. They were a mix of civilians and Australian Defence Force reservists, the latter with field experience or experience working in developing countries. Team Echo had a little more time to prepare than teams Alpha and Bravo.5 First, they had to demonstrate that all team members were fit, in good general health, and had their vaccinations up to date, including those to protect against adult diphtheria, tetanus, and hepatitis A and B viruses. In addition, they all were required to commence taking prophylactic antimalarial medication (ie, doxycycline). The team members had to formulate a list and pack all supplies that would be needed: surgical instruments, medications, resuscitation equipment, food, bedding, communication equipment, and personal safety equipment, as well as water. Their load inventory, sourced from the state health department supply warehouse and local public hospitals, weighed 10,000 kg, was packed on four pallets, and included 4,000 kg of water. On arrival to Banda Aceh, the members of Team Echo established themselves in the same hospital at which Teams Alpha and Bravo had operated. It had two ORs, a small, one-bed postanesthesia care unit (PACU), and an instrument processing and sterilization area, which included a very small sterilizer (ie, large enough to hold several kidney trays only). Despite this, the team felt lucky because this was a relatively good setup given the circumstances. The team very quickly set up a system to create and coordinate surgical schedules, and procedures were restricted to 13 per day. This was a risk management strategy to combat fatigue from disrupted sleep caused by continuing earth tremors and working in extreme heat and humidity. The team also established effective communication between a Malaysian aid team based at the local airport and the Estonian aid team that was running the emergency department, which resulted in appropriately triaged and prepared patients (ie, fasted) arriving to the OR at the right time. The lack of running water in the ORs resulted in the necessity to use ethanol 66% hand gel instead of undertaking standard surgical scrubs. Because of the high ambient temperature (ie, 38° C [100° F]) and humidity (ie, 98%), the practice of wearing sterile gowns was abandoned; instead, surgical team members wore sterile plastic aprons. The limited number of disposable drape packs available to Team Echo resulted in their use being restricted to larger, more invasive procedures only, and standard draping practices were modified. One example was the use of sterile plastic aprons to drape instrument carts. In the absence of linen, the OR bed was protected by a body bag, which was subsequently used to transport the patient from the OR to the PACU and then to the ward. Each team member was issued a battery-powered headlight, which was carried at all times in a backpack, along with the team member's passport, a change of clothing, and a water bottle. The team used the headlights on several occasions when power went out during surgery.6 The local practice of disposing of all contaminated waste and sharps in a trash bag was maintained. The bags were then placed in a waste pit situated 20 meters from the OR door, along with all other hospital waste, and the contents were burned daily, rather than infrequently as before. The burnings were coordinated around the afternoon monsoonal shower, which subsequently reduced the number of stray animals (eg, cows, goats, dogs, cats) scavenging in the vicinity.5 The surgical experience of patients is a family affair in Aceh, and the patients' necessarily brief care in the PACU, into which the preoperative waiting area opened, was no exception. One or more of each patient's family members crowded into the small PACU as soon as a patient entered it, and, because it was culturally inappropriate to deny them access, they were embraced and encouraged. Much advice was given and received, not only from family members but from those waiting for surgery; preoperative patients and their family members gave health care advice to postoperative patients and their family members. The family members, who cared for the patients on the ward, were often instrumental in transporting them there as well. Team Echo performed 127 procedures during their 11 days in Banda Aceh. The majority of these interventions was on young adults with soft-tissue injuries, with 91 being performed on lower limbs; this included debridement, split skin grafting, and suturing and redressing of wounds. Seven procedures were performed for non-tsunami-related conditions. Sadly, there was a noticeable lack of surgery on children or older patients because fewer of them survived the tsunami.6 What lies below the cold veneer of facts and figures is the question of what this humanitarian activity meant, particularly for those civilian perioperative nurse team members with little or no field experience. The surgical teams that delivered care in Banda Aceh in the aftermath of the 2004 Indian Ocean tsunami had to modify many of their care practices and be innovative and creative, as well as culturally sensitive to local conditions and practices. They worked their way through the many clinical issues associated with practicing outside of recognized Australian College of Operating Room Nurses standards; nonetheless, they believe that they delivered a good standard of care despite the difficult and challenging conditions in which they found themselves.5, 6 The team members were deeply moved by the dignity and forbearance of the Acehnese people in the face of such an overwhelming disaster and felt privileged to have been able to help at least some of them. They forged strong relationships with the Indonesian nurses and other international nursing groups, and provided education on current best practice when it was sought. I acknowledge that, in this article, I only scratched the surface of one event and have done so from a narrow, Australian perspective. There are very many humanitarian efforts in which perioperative nurses have participated globally. Past events, for example, Hurricane Katrina, and more recent ones, for example, the crisis in Haiti, prompt offers of help. For information about volunteering during disasters, see the article posted on Medscape Nurse News7 at http://www.medscape.com/viewarticle/716386 [free membership required].

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.