Caring for tsunami victims in the ruins of Banda ACEH.

Amid the wrecked landscape of the city of Banda Aceh, New Zealand nurses are among the health professionals caring for local people in the kind of working conditions few nurses in this country would have experienced.

New Zealand nurses have been playing their part in the health teams at work in the tsunami-devastated Indonesian province of Aceh.

Wellington Hospital emergency department nurse Marion Picken left for the province's capital, Banda Aceh, in late January to work in a Red Cross field hospital. And two New Zealand (NZ) Army nurses, Captains Georgina Parata-Purvey and Rose Fraser, recently returned from a month as part of a NZ Army medical team working at Banda Aceh's main public hospital. And army nurses were also working onboard Royal New Zealand Airforce (RNZAF) planes working in Phuket, Thailand, and Indonesia. The nurses faced very difficult working conditions in the part of South Asia most devastated by the tsunami, which hit Indian Ocean coastlines after an under-sea earthquake on Boxing Day, 2004.

Captains Parata-Purvey and Fraser, of the 2nd Health Services Battalion, based at Linton, near Palmerston North, arrived in Aceh on January 9 as part of a NZ Army light medical team. They were deployed to work alongside an Australian Defence Force medical company, and together they set up an "Anzac Hospital" within Banda Aceh's seriously damaged public hospital.

Defence spokeswoman Sandy McKie said the 450-bed hospital had had 900 staff before the tsunami struck, but the director of the hospital had reported that less than half the staff had survived. Of those, only about 30 had since returned to work.

Wrecked equipment

She said the hospital had suffered both earthquake and tsunami damage. Local people and the Indonesian military had done an initial clean-out, clearing wrecked equipment and debris out of wards. Beds and surgical equipment covered in dirt and silt and sewage had to be cleared out.

"Then our people went in and did the next stage of the dean-up and set up wards." The Anzac hospital had set up an outpatients department, isolation ward, a surgical ward and an operating theatre. The most recent addition, in late January, was an infectious diseases medical ward with 20 beds.

McKie said some of the patients they were seeing were local people who had received some initial treatment for injuries straight after the disaster, but nothing more. One of these was an Indonesian woman who turned up at the hospital with a Large piece of glass in her leg, which had gone septic. Initially staff thought they might need to amputate, but were able to save her leg.

They were also treating broken bones, children who had inhaled dirty water and presented pneumonia-type symptoms, and some cases of malnutrition and dehydration. And a woman had given birth at the hospital by emergency caesarian section.

Some patients had injuries received after the tsunami caused by going into unsafe buildings, she said.

McKie said the hospital had only limited generator power and a very limited water supply, and army staff had only recently been able to rig up showers. They had had to build outside toilets and there was very Little fresh food--they were mostly eating ration-pack meals.

"Environmental conditions are the worst you could imagine. There's mud, sewage, equipment like needles in the mud, roaming dogs, stench. And there are still wards in the hospital that are untouched since the disaster."

Also, there had been lots and lots of rain, on top of already sodden ground.

The medical team was to be rotated out again after a 30-day deployment, and the staff were due to arrive back in New Zealand on February 8. They were being replaced by another team who were due to leave New Zealand on February 3. "You can't leave people in an environment like that too long. They work long hours, they don't leave the area, they're surrounded by devastation and they've done a lot of physical work--you just wear them out."

McKie said there had been good co-operation between the Indonesian health authorities, aid agencies and the different military medical teams from around the world. The military medical teams were co-ordinating care, and sharing ward rounds and equipment.

Picken left Wellington on January 25 for a six-week stint in Banda Aceh, working in a 100-bed Red Cross MASH-type tent hospital.

An emergency department clinical nurse coordinator for Capital and Coast District Health Board, she would be working with other Red Cross medical professionals from around the world.

"I am expecting really basic conditions but I think sometimes the basics are all you realty need," she said before she left.

"The Red Cross has high standards and we have got very skilled people who are well-prepared to work in these kinds of crisis situations, so it is great to be part of that team."

Picken said her emergency department experience would help her in Banda Aceh. "Working in an emergency department, you never know what is going to come through the door and you become multi-skilled, so you can deal with looking after small sick children to a big multi-trauma and you learn how to keep calm when chaos hits."

She would be working in a Norwegian Red Cross field hospital which would be flown in. "When I arrive, it should be set up and functioning. I will be working as a ward nurse and also as a midwife.

"We will be working with war wound kits--these huge kits that have everything from operating equipment down to bed sheets, everything you could need."

The Wellington nurse is no stranger to difficult working conditions overseas, as this is her fourth mission for the Red Cross--she has worked in Afghanistan and twice in Sudan. Army nurse Captain Deb Blythen, who is stationed at the Ohakea Air Force base, near Palmerston North, worked as part of an aero-medical evacuation team on board one of two RNZAF C130 Hercules aircraft which flew to Asia to help the relief effort.

Initially her aircraft was sent to Phuket, Thailand, in late December, to try to locate injured New Zealanders and bring home any who were well enough to be shifted. Blythen said there was a lot of confusion in Phuket, with a big international relief effort starting up, and she and a doctor had seven or eight hospitals to check out.

Two days later they were sent to Jakarta, where the New Zealand aircraft carried aid freight up to Banda Aceh and evacuated local people on the flights back. These people included the injured, women and children and elderly Indonesians.

She said people praised her work in the relief effort as "wonderful" but she was just doing her job. "It's sometimes a hard job, but like most aspects of nursing, it can be quite rewarding."