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Earthquake! MT duty on a medical aid team.

Earthquake! MT duty on a medical aid team

My unforgettable one-week work odyssey started with a rush.

On Monday morning, Oct. 21, 1985, a fellow member of the California Association for Medical Technology phoned me at my hospital laboratory. She asked if I could join a health care team organized by the Salvation Army to help earthquake victims in Mexico City. Thanks to my supervisor and co-workers, who agreed to cover the unplanned absence, I was able to answer yes. Sleep was low on the list of priorities over the next 36 hours as I hurried to sign up for the team, rearrange my personal schedule, pack, and get off.

Then I was aboard a Tijuana-Mexico City flight 29,000 feet over the Gulf of Mexico, listening on a Walkman to Beethoven's Ninth Symphony. The morning sun glistened beautifully on the water below. It all had the quality of a dream, but reality set in soon after we landed. Pockets and larger areas of devastation rolled by as we drove from the airport to our medical clinic in Colonia Morelos, a Mexico City quarter hard hit by the earthquakes of Sept. 19 and 20.

Our team of 19 consisted of two pediatricians, two general practitioners, a neurologist-internist, an emergency physician, a physician's assistant, nine registered nurses, a pharmacist, a psychologist, and a medical technologist. One of these people was my wife. I had listed her as next of kin on my application to join the team, and medical director Scott Ferris, M.D., noticed her hispanic surname: Munoz-Ross. When he learned from me that she spoke Spanish fluently and was a nurse, an invitation went out to her.

The majority of our team was Spanish-speaking. That minimized our need for interpreters, although several fine translators were always available to help overcome difficulties in communication.

La Clinica Esperanza, the Clinic of Hope, was set up in a church sanctuary occupying half of a large Salvation Army building. The other half of the building contained a large warehouse and the dormitories where we slept.

We held our morning staff meetings on church pews shifted around to face each other. Once the clinic opened, the pews became a waiting area for patients. Other pews served as doctors' office areas and a waiting area for triage and the pharmacy. At mealtime, the same pews became the cafeteria. Wooden doors and sheets of plywood on sawhorses were used as examining tables for pediatric patients and as surgical tables for minor suturing.

Clinic hours ran from 9 a.m. to 1 p.m. and from 2:30 p.m. to 5 p.m. Outpatients started lining up outside the door as early as 7 a.m.; we saw between 230 and 300 throughout the day.

Upon registering, patients received a 3 5-inch piece of paper that became their medical record. Next stop was the triage area, where nurses took vital signs, documented the primary medical problem, and sent each patient to the most appropriate physician. After seeing a doctor, the patient went to the laboratory and/or the pharmacy.

All of this occurred in one large unpartitioned room. The only sites curtained off were a corner of the lab area for patients to provide urine and stool specimens and two tables for pelvic and rectal examinations.

Nurses didn't have to call me on the phone for laboratory results. They just walked 10 or 20 feet to the lab table and asked. Similarly, I walked over to a doctor whenever I had a panic value. This physical closeness nurtured the strong team spirit that we all grew to feel. Being in one big room, we could see how each member fit into the team as a whole.

We often pitched in to help each other out. The pharmacist and I swapped supplies, for example, and nurses collected blood and urine when I was very busy. My wife worked mostly in triage, however--we saw no more of each other during clinic hours than we do in our jobs at different San Diego hospitals.

Many patients complained of maladies that have been dubbed post-quake stress syndrome: constant dizziness and a feeling that the earth was still moving, nausea, insomnia, anxiety, general malaise, and lethargy. Such symptoms made the physician's diagnostic task all the more difficult.

Our staff psychologist, Robert Matusiak, Ph.D., encouraged nurses and doctors to let patients know that their psychological trauma was as important as their physical injuries. He himself had survived dozens of serious earthquakes as a Peace Corps volunteer in Peru. Since we would be gone in a week, he contacted a local school of psychology to make longer-term support available for those with lingering effects.

One woman who was referred to Dr. Matusiak had lost her husband, a building painter. The family lived outside Mexico City, safe from the earthquakes, but the man had slept in town at a job site--and died there--because it was too expensive to commute. A month after the quakes, she still did not know how to tell her eight children that their father was dead. The kids chatted in the clinic about soon seeing him again.

The widow had no money. She put sugar and water in her infant's bottle because she could not afford milk. Despite her embarrassment, two of the doctors insisted she take $20 to buy food. A nurse offered the older children some fruit she had been saving for lunch. The polite youngsters waited for permission from their mother; when they devoured the fruit, it was apparent they had not eaten in days.

In the laboratory, I was able to offer a fair variety of tests because of supplies contributed by several San Diego hospitals, part of 700 pounds of donated material that accompanied the Salvation Army's San Diego medical team. These supplies came on top of donations brought down by previous volunteer teams from Tacoma. Seattle, Portland, El Paso, Los Angeles, and San Francisco.

I had use of the following: a binocular microscope with 100 oil and 10 low-dry objective lenses, two Neubauer hemacy-tometers, a microhematocrit centrifuge, a six-tube centrifuge for spinning urines, a battery-operated glucometer, an autoclave (my clinic "job description' included sterile processing), a number of stains, lots of different urine dipsticks, a 100-test slide pregnancy kit, and anything I could get from central supply (needles, gauze, alcohol, etc.) or the pharmacy (graduated cylinders and pipets).

The laboratory work bench was a single six-foot table. Four chairs were available for patients waiting to be drawn. Central supply set aside a couple of shelves as the lab storage area.

According to the log sheets, my daily workload consisted of 2 to 15 spun hematocrits, 2 to 15 manual WBCs, 2 to 10 differentials, 1 to 3 manual platelet counts, 5 to 30 urinalyses with microscopic exams, 1 to 15 KOH preps and wet mounts, 1 to 4 Gram stains, 1 to 7 slide pregnancy tests, 0 to 14 wet mounts for ova and parasites, and 5 to 15 fingerstick glucoses. During the entire week, I also performed 2 pinworm Scotch tape preps and 1 reticulocyte count.

All blood tests were done directly from a fingerstick. Except for glucose, I did not have access to any blood chemistries, even at a reference lab. So there was no need for venipuncture.

Results were often not what I expected. For example, I did not see too many parasites. Of the week's total of 26 stool specimens, there were only three with Ascaris lumbricoides eggs and two with Entamoeba histolytica cysts. Two of the Ascaris and one E. histolytica were in one family.

Only one out of the more than 90 urines tested during the week had Trichomonas in it. None of the 35 KOH/wet mounts had Trichomonas or budding yeast. The pediatricians saw quite a bit of scabies, but sent me just one skin scraping on an atypical-appearing lesion, which was positive.

Many patients had blood glucoses over 150 mg/dl, and several exceeded 250 mg/dl. Some were diabetics whose medicine had been lost in the rubble of their destroyed homes, and some were newly diagnosed diabetics. I wondered how many of the latter cases were stress reactions to the trauma of the earthquake.

Almost all patients--men, women, nursing mothers, small children--had spun hematocrits that were toward the high end of normal. I started to doubt the microhematocrit centrifuge until I did spun crits on myself and others from San Diego to confirm its accuracy. The combination of high altitude--Mexico City is a mile above sea level--and dehydration due to scarcity of potable water probably accounted for the high hematocrits.

A 75-year-old woman had a differential that I called to her clinician's attention. Her WBC was normal at about 8,000/mm3, but she had 64 per cent lymphocytes that were monotonously small, dark, and hypermature. There were also a few smudged cells. The clinician, finding the patient weak and fatigued, could not differentiate in diagnosis between post-quake stress syndrome and the chronic lymphocytic leukemia that I suspected. The patient was referred to another hospital for more thorough examination and testing.

I found pronounced toxic granulation in a young mother's segmented neutrophils; they were nearly as coarse-grained as eosinophils. She was also slightly anemic. The doctor determined that she ate handfuls of dirt as a result of quake-related stress. Our psychologist told us he had seen many cases of stress-induced geophagia. The woman knew it was abnormal but couldn't stop. She was referred for longer-term counseling.

Doctors provided immediate, positive feedback to the nurses and me. For example, a pediatrician took a moment to come back and thank me right after I reported E. histolytica in the stool of a very young child with bloody diarrhea. The doctor was able to prescribe the appropriate medication at once. He said that with only the symptoms and no positive wet mount, he would have placed the child on antibiotics for a week before trying anti-amoeboid drugs.

The earthquake had ruptured mains all over the city, so water was in short supply. After brushing my teeth one morning, I was forced to rinse with apple juice. (Other trips to Mexico had taught me always to take along canned juices.)

The Salvation Army gave us three meals a day cooked by local volunteers. Nurses and doctors closest to the kitchen area of the church would have to wait for the noise of the electric blender to stop before applying their stethoscopes to patients. The quality of the food was excellent, although some team members with tender stomachs could not cope with the spicier dishes.

The medical team and other Salvation Army volunteers were much better off than the thousands rendered homeless in the Colonia Morelos barrio. The most fortunate of these people lived in tents supplied by the Red Cross and the Salvation Army. Others occupied shacks built of scavenged plastic sheeting and cardboard. And the least fortunate slept in rubble or the street--we saw many outside our building.

Many local residents ate only one meal a day, provided on the Salvation Army soup line. They got their daily ration of water in plastic bags handed out from government trucks.

Before the clinic opened in the morning, a number of medical team members helped prepare 3,000 sandwiches a day for distribution --along with beans, soup, and coffee--to volunteer salvage workers at several Salvation Army canteens around Mexico City. Food and drink were also given to releatives of the dead and missing, who still kept a vigil six weeks after the quake to identify any remains found.

We took a late-night ride on one of the trucks that delivered meals to the canteens. That's how we came to see all that remained of 3,000-bed Hospital Juarez: a concrete basement with a few traces of foundation and pilings. Its 12 stories had collapsed into four stories of rubble, which had now been cleared away.

Physicians from all over the city had gathered at Hospital Juarez for a convention before the quake struck. More than 400 doctors died there on Sept. 19. One of our own physicians lost her 23-year-old cousin. He had started his residency Sept. 1.

There was a great loss of life at clothing factories in Mexico City's garment district. The mid-night scene reminded me of a movie set. Huge arc lights lit up the damaged buildings, many of which had only facades left. Large construction cranes resembled camera booms. Workers moving through the ruins cast surreal shadows on those walls that were still standing.

It was not a movie. The grieving families, the wide vacant eyes of the emotionally drained workers, the dust of crushed hopes on my shoes were all real. The stack of plain wooden coffins, six high and a dozen long, was real.

I am glad I had the opportunity to see it all for myself. The impact was immeasurably more potent than looking at photographs or TV reports in the comfort of my home. I learned about the strength and faith of people who lost what little they had.

The gratitude in the words and eyes of patients is very great. Many still are in desperate need of help. La Clinica Esperanza had seen more than 8,000 patients by the end of 1985, but Mexico City has over 18 million inhabitants.

After extensive negotiation with the Mexican government and with the approval of the Salvation Army's international headquarters in London, the clinic has been set up as a permanent facility staffed by Mexican medical personnel. It also has a mental health component with a staff of 12 volunteer psychologists.

If you would like to insure the survival of this important facility, please send a monetary donation to your local or area Salvation Army headquarters. Earmark it for La Clinica Esperanza, The Salvation Army, Mexico City. I can personally attest that such donations directly help people in need.

Photo: The complete one-room medical clinic

A morning staff meeting at the Clinic of Hope is led by David Levison, M.D., assistant medical director, second from left. The author is next to him on the right. They are seated on church pews.

The laboratory work bench was a six-foot table. Instruments included a binocular microscope with 100 oil and 10 low-dry objective lenses.

The entire clinic was set up in one large unpartitioned room. In the foreground was the triage-receiving area. At the rear, a pharmacist dispensed drugs.
COPYRIGHT 1986 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1986 Gale, Cengage Learning. All rights reserved.

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Title Annotation:medical technologist
Author:Ross, Richard T.
Publication:Medical Laboratory Observer
Date:Sep 1, 1986
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