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Relationship Building and a Story of Hope in Tsunami-Ravaged Banda Aceh, Indonesia: Perspective of a US Public Health Service Nurse

2005; American Association of Critical-Care Nurses; Volume: 14; Issue: 6 Linguagem: Inglês

10.4037/ajcc2005.14.6.474

1937-710X

LCDR Thomas Pryor,

Disaster Response and Management

On December 26, 2004, the world witnessed one of the greatest natural disasters in recorded history. That event was described to me by a survivor as “a hand that reached out of the ocean bringing death and chaos to whatever it touched.” To date, more than 300 000 people are dead or missing, and damage estimates are in the millions of dollars. No area was ravaged more than the province of Banda Aceh, Indonesia, less than 150 km from the epicenter of the estimated 9.0 earthquake that created the tsunami.My involvement in the tsunami relief effort was as a nurse for the US Public Health Service (USPHS), serving under the direction of US Surgeon General–Vice Admiral Carmona. The mission of the USPHS is to “Protect, Promote, and advance the health and safety of the Nation.” In this case, however, the mission took on global implications as I was assigned to the US Navy hospital ship Mercy as part of an integrated coalition of US Navy, USPHS, and Project Hope medical and nurse volunteers. As a part of Operation Unified Assistance, we were deployed off the shores of Banda Aceh to offer humanitarian assistance to the Indonesian government and most of all to the people of tsunami-stricken Banda Aceh.My experience revolved primarily around the care I provided a 12-year-old boy whom I referred to in my journal as “Harapan,” which is Indonesian for Hope. Harapan had “tsunami lung” (a severe lung infection caused by swallowing muddy, bacteria-laden water), and sepsis and complete respiratory failure developed subsequently. Emergently intubated, Harapan was handed to Mercy staff onshore and was then brought by helicopter to the ship.Harapan required aggressive respiratory and ventilator management, blood transfusions, antibiotics, vasopressors, and various other types of medical support in the weeks that followed. Yet his medical situation was only a part of his incredible story. Harapan’s story of resilience and fortitude was told to me at his bedside by an uncle during the many hours of nursing care I provided. The story began 2 days after the tsunami, when Harapan was found by local fisherman floating on a piece of debris in the ocean and was taken to a displaced persons camp. Weeks later, his uncle found him and told Harapan that the boy’s parents, siblings, and extended family (consisting of 40 people) had all been killed by the tsunami; only Harapan’s uncle, aunt, and their child survived. To this day, I can’t begin to imagine his aunt’s anguish as she watched one of her last surviving relatives being taken by helicopter to the “big white ship from America”—initially viewed by the Indonesians with suspicion and uncertainty—across the same ocean that had initially taken Harapan along with all of her relatives.During this same time, the Mercy and its diverse crew had many opportunities to promote the spirit of health diplomacy through our commitment to providing care to those in need. Despite any real or misconceived perceptions regarding the political, social, cultural, or religious differences between countries, the willingness of the staff of Operation Unified Assistance to build relationships based on compassionate bedside care was furthered by the partnership of various international nongovernmental organizations, governmental agencies, and the people onshore. A continuum of relationship building sustained through trust and goodwill ultimately served to heal the overwhelming tragedy caused by this disaster, illustrating not only the heroism of the survivors but that of the caregivers and aid workers who responded.These profound relationships had the potential to change local and international beliefs, both individually and collectively. According to a poll released by the Heritage Foundation, “In the first substantial shift of public opinion in the Muslim world since the beginning of the US global war on terrorism, more people in Indonesia, the world’s largest Muslim country, now favor American efforts against terrorism than oppose them. . . . The poll shows that the reason for this positive change is the American response to the tsunami . . . .” The Mercy and its crew provided a model of health diplomacy based on humanitarian principles and global health ideals. I hope that these ideals will endure and be furthered in a world community that can often separate and isolate itself through its own global differences and indifferences.Miraculously, after 4 weeks of providing one-on-one nursing care, I had the unforgettable experience of escorting Harapan back to Banda Aceh, where he was reunited with his “new family.” As we embraced and said our goodbyes, Harapan and each member of his family held my hands and said, “Terima kasih, menyetujui cinta dan kelaurga kami,” which means thank you and accept our love and family. Harapan’s family will forever be held close to my heart and will be remembered as one that found hope in the midst of despair.