Family Physicians in Earthquake Ravaged China – Report #2

Last week I posted a report from my friend, Chris Place, M.D., from the Hope Medical Clinic is Macao, China, about a team he was leading in the earthquake ravaged area of Chendu, China.

Here are Chris’ sobering diary entries of his experiences there.

Abbreviations are used for security purposes. 

Chris has returned from leading a team of 3 docs and 2 nurses to Sichuan to provide medical care to survivors of the Wenchuan earthquake. This weekend the team is debriefing and and preparing the second group to leave on Tuesday. HOPE has committed to the recovery process for the long-term, and will be sending multiple teams over the coming months. This update is from Chris’s journal kept during the trip. 

Day One … Arriving into “organized chaos” 

Team arrives at H2H headquarters – their small community center transformed into an EOC (Emergency Operations Center) – many people here. Stations are set up with large paper posters – “Step One – Pick up Forms”, “Step Two – Orientation”, etc. 

We learn we are one of only a few medical teams – but all the big guys are represented – EG, MSI, KM – good to see docs that we just visited with in Xiamen – who knew what was coming then? Most teams are enthusiastic volunteers going for supply runs. There is a semblance of organization but we quickly learn it will be challenging getting on the road. 

After about 3 hours of waiting and organizing, our team is complete – the five of us, four drivers, three Koreans, two H2H nurses, one local Sichuan-hua speaker, and two foreign linguists who will “carry stuff.” Eventually the Koreans bow out – they need to leave too early tomorrow and we’re planning on camping. 

All waivers are signed and we stand for our team picture. Our Chinese team is familiar with the group picture – I decide not to tell them that H2H does the picture so in case someone gets lost or goes missing they have a picture to give to authorities. A reporter from CNN Asia asks if her crew can join us. I defer her to H2H and they wisely decline. 

Two hours of driving through absolute destruction. Tent cities on every corner. Buildings destroyed. Workers still picking through the rubble. Finally arrive at SS, a city with lots of damage and a destroyed hospital. The “hospital” is under the town market awning – a huge area with hundreds of people on the ground here – temporary tents are set up for pharmacy, wards, sleeping quarters for staff. It is clean and orderly. The basic supplies (water, food) are ample.

The hospital president and medical director are gracious and kind – as usual they offer us a seat and a drink of water. They ask for CT scanners, X-Ray equipment, ultrasound machines, basically everything they’ll need to re-open the hospital. We tell them we have a few boxes of meds and lots of caring hearts. We ask to see the hospital. 

We walk with the hospital president through the town. Only now do we realize that we are actually on the edge of a totally destroyed city. We walk through street after street where there is not one other human being. This city looks like parts of my own sown South – only there should be hundreds of people milling about – now there is nobody here – a ghost-town. The smell of the dead is pungent from the surrounding buildings. We see groups of soldiers with shovels. They wave and flash us the “peace” sign – I love Chinese people :) These guys have a hard job – real heroes… 

We arrive at the hospital compound – not one building is usable. Several sit at oddly tilted angles – deep cracks through and through up the sides to the tops of 5-6 story buildings. We stop in an open courtyard and the president tells his story. 

“Here’s where we pulled the dead and injured from the hospital. Our doctors were sewing people up as fast as they could work, then dragging them out to safety.” There are drying blood stains on the pavement here. It finally really dawns on me that all this happened less than one week ago to these people. Those same doctors are now assigned to surrounding villages and caring for their patients in the tents. Even though they are traumatized and exhausted they continue to work. 

We return to the temporary hospital. On our way back, our Sichuan-hua speaker is quietly crying and holding hands with one of our nurses – the full impact of the experience weighs heavily. Every building in this town will need to be demolished. Back at the temporary tent hospital, one of the linguists sits in a circle of about 20 kids and teaches them a goofy game. They are laughing and playing. I realize this may be the real purpose of the visit today. After another official meeting to make plans for future groups we leave. Everyone profusely thanking us as we depart (for what?) The vans are quiet as we drive away. 

Day Two – To SS and a destroyed hospital… 

Team arrives at H2H headquarters – their small community center transformed into an EOC (Emergency Operations Center) – many people here. Stations are set up with large paper posters – “Step One – Pick up Forms”, “Step Two – Orientation”, etc. 

We learn we are one of only a few medical teams – but all the big guys are represented – EG, MSI, KM – good to see docs that we just visited with in Xiamen – who knew what was coming then? Most teams are enthusiastic volunteers going for supply runs. There is a semblance of organization but we quickly learn it will be challenging getting on the road. 

After about 3 hours of waiting and organizing, our team is complete – the five of us, four drivers, three Koreans, two H2H nurses, one local Sichuan-hua speaker, and two foreign linguists who will “carry stuff.” Eventually the Koreans bow out – they need to leave too early tomorrow and we’re planning on camping. 

All waivers are signed and we stand for our team picture. Our Chinese team is familiar with the group picture – I decide not to tell them that H2H does the picture so in case someone gets lost or goes missing they have a picture to give to authorities. A reporter from CNN Asia asks if her crew can join us. I defer her to H2H and they wisely decline. 

Two hours of driving through absolute destruction. Tent cities on every corner. Buildings destroyed. Workers still picking through the rubble. Finally arrive at SS, a city with lots of damage and a destroyed hospital. The “hospital” is under the town market awning – a huge area with hundreds of people on the ground here – temporary tents are set up for pharmacy, wards, sleeping quarters for staff. It is clean and orderly. The basic supplies (water, food) are ample. 

 

The hospital president and medical director are gracious and kind – as usual they offer us a seat and a drink of water. They ask for CT scanners, X-Ray equipment, ultrasound machines, basically everything they’ll need to re-open the hospital. We tell them we have a few boxes of meds and lots of caring hearts. We ask to see the hospital. 

We walk with the hospital president through the town. Only now do we realize that we are actually on the edge of a totally destroyed city. We walk through street after street where there is not one other human being. This city looks like parts of my own sown South – only there should be hundreds of people milling about – now there is nobody here – a ghost-town. The smell of the dead is pungent from the surrounding buildings. We see groups of soldiers with shovels. They wave and flash us the “peace” sign – I love Chinese people :) These guys have a hard job – real heroes… 

We arrive at the hospital compound – not one building is usable. Several sit at oddly tilted angles – deep cracks through and through up the sides to the tops of 5-6 story buildings. We stop in an open courtyard and the president tells his story. 

“Here’s where we pulled the dead and injured from the hospital. Our doctors were sewing people up as fast as they could work, then dragging them out to safety.” There are drying blood stains on the pavement here. It finally really dawns on me that all this happened less than one week ago to these people. Those same doctors are now assigned to surrounding villages and caring for their patients in the tents. Even though they are traumatized and exhausted they continue to work. 

We return to the temporary hospital. On our way back, our Sichuan-hua speaker is quietly crying and holding hands with one of our nurses – the full impact of the experience weighs heavily. Every building in this town will need to be demolished. Back at the temporary tent hospital, one of the linguists sits in a circle of about 20 kids and teaches them a goofy game. They are laughing and playing. I realize this may be the real purpose of the visit today. After another official meeting to make plans for future groups we leave. Everyone profusely thanking us as we depart (for what?) The vans are quiet as we drive away. 

Day Two, cont’d… To MY…

More driving, driving, driving today. We stop to ask directions (we spend a lot of time lost) – someone shouts outside that we have doctors in our van – a woman runs up screaming. She says they have found someone alive in the rubble – she gets into our van now – begging for us to drive – somewhere, anywhere. 

Finally our Chinese docs calm her down. The area she’s talking about is 4 hours away on foot up in a remote area of the surrounding mountains. We’re not even sure how she knows this or if the report is real or current – we take her to the military representative standing nearby who begins to help her. Our group drives away confused and dazed after the raw emotion and chaos drains slowly away. On to the staging area for MY. 

Arrival at MY, we check in at Red Cross station. Everyone must sign and time their arrival and departure in order to account for individual workers coming into the zone. The clock tower here has stopped at 2:28 PM – the day of the quake. The RC docs and nurses want to take a picture together. It reminds me of so many other times I’ve taken a group picture in China under different circumstances. 

A man runs up with news of a small village up the road with injured that cannot make it down to the staging area. He guides us up the hill as far as the van can go, then we walk. Mixed into the destruction, It is breathtakingly beautiful here – green mountains and tiny Chinese farms everywhere. 

Finally reach a tiny village nestled in the hills – after climbing into a beautiful pear orchard there is a small tent here – an 81-year-old woman, blind and mostly deaf, is laying here (we are told that before the earthquake she was a productive field worker!) I diagnose a fractured left tibia and right foot. She has developed sacral decubiti (bedsores) from her immobility. She is covered in excrement and urine. Her son explains there is nothing for them to do with her but she refuses to leave the mountain. Our team struggles – should we force her down? Where will we take her? To the overwhelmed hospital we just visited? She most certainly will not survive these fractures in these conditions. Is it better for her life to be finished here in her home village on her mountain with her family or in the temporary hospital among total strangers? 

We change the splint on her leg, clean her up and dress her wounds, pray with her. We teach the son and daughter-in-law how to turn and care for her. Later we’ll inform the local village health worker who will visit her he says – we wonder if he’ll be able to reach her with the overwhelming need all around him. 

It’s getting dark. The team is conflicted. Some want to stay and camp here, but more are frightened and worried. After a team vote, I decide to take us back into Chengdu for the night. We arrive after 11 – there’s a city-wide aftershock warning. Complete chaos. People are running from buildings for the parks – the main street outside is a parking lot of fleeing people in cars. Our hotel manager assures us his building is 8+ earthquake proof – we feel reassured that it survived the first quake and the aftershocks are estimated at 5-6 if they occur. We are actually too tired to care much about anything but sleep. I realize the incredible power of fear. It is amazing to see it ripple through the community. The linguist with us from Southern California is frustrated – he thinks the warning (and the panic it has induced) will endanger more people than the aftershocks. I think he is right. 

We don’t find out until morning that the hotel was evacuated at 1 AM – and we slept through it all. Many people slept in the lobby and the hotel restaurant, but we remained in our rooms – oblivious from our exhaustion. Can’t help but be a little glad we didn’t have to sleep in the lobby. 

Day Three… The long drive to PG… 

We arrive at H2H headquarters at 7:30 AM. Few drivers today because of last night’s warnings. Finally arrange one car and one SUV which I drive – thank goodness for my Chinese license :) 

We are to go on an exploratory trip to a far-flung village in Beichuan county to see what the medical needs/possibilities are there. We drive over 4 hours to get there through amazing beauty shrouded by total destruction. Multiple checkpoints and sealed areas. No pictures allowed. Disinfectant stations and mosquito sprayers douse the cars, open our doors and spray our feet and floor-boards. Soldiers everywhere. 

“Masks on” the soldiers say. Our Red Cross placards have allowed us access into these areas. We stop at several mountain roads where boulders the size of our van are sitting weirdly in the road – their paths can be traced from the cliffs above right through mountain- side houses to their resting places here. 

We drive past one of the many “landslide lakes” – where a river has been dammed and has inundated a small village – this one is totally underwater. 

We drive through multiple areas where landslides have occurred. Our mountaineering linguist tells us not to worry as landslides occur regularly up here even without the earthquake – he has done mountain- biking in the area. We are not very reassured. 

We must drive through a half-mile-long tunnel that is pitch black through one of these mountains. Although it has been deemed safe by Chinese engineers it completely creeps me out. So dark. There is rubble inside we assume from the quake. There is water dripping from the ceiling – quite a lot in one section. We are glad to emerge from the other side. Too bad we’ll have to drive through this again on the way back. 

We reach one small village with an individual Chinese doc who has set up shop. He tells us to donate meds to him – he is “only charging patients who were not affected by the earthquake” – we look around – who here has not been affected by the earthquake? We politely leave – donating just a few of our meds afraid of his opportunism. 

Finally reach our destination of PW. This area is still fresh – all military. There are still people coming down from the mountains. They cannot use our help or our medicines. We leave our water and food, encourage the camp leader. It is getting late – I’m afraid of our team needing to drive in the dark and rain is starting to fall. We depart as quickly as possible and make it safely back by 10 PM. Everyone is starving, so we have hot-pot back in Chengdu This turns out to be a gastrointestinal mistake for several of the team. We bid farewell to our linguists – they are leaving tomorrow. Everyone sleeps heavily again, back out in the morning. 

Day Four… To MY county villages…  

Team is up again early. Today we get out faster after arranging our vehicles the night before and limiting the size of our group – not taking additional members. Two hours of driving to remote villages around MY – these are in the flat-lands – rice and grain farmers mostly. 

There is not one building left standing in any of these villages. Everywhere we go are people on the sides of the roads living in tents. Each group is grateful as we stop and hand out water and rice to the adults, or candy to the kids. 

I am amazed at the ingenuity. Each tent is divided into a front “kitchen” area where the wok is set on cinder blocks over a fire – and a back section for sleeping. All tents are laid over slabs of individually set bricks that have been collected from the rubble. They have been laid out carefully with drain cracks and covered with plastic sheeting. 

Finally reach a small village area of about 200 people. We set up a village “clinic” in the center and begin seeing patients. Our HOPE-trained Chinese docs are amazing – they quickly organize, take names and assign numbers, set up vital sign areas, pharmacy and exam areas. Within 3 hours we have seen over 60 patients. We give out tons of vitamins to the kids and I see the wounds with a nurse – lots of contusions and healing lacerations. Lots of kids with scabies and other skin problems. 

Our Sichuan-wa speaker becomes critically needed as our Mandarin speakers have difficulty understanding some of the older patients. Before we leave, one of our docs leads the group in a song. They want to sing the Chinese national anthem. We are all crying as we leave. 

Back to Chengdu after getting lost several times. We are in earlier tonight – all of us are already beginning to detach and plan for our return home. We are bringing in reinforcements soon and we know we cannot keep up this pace. As doctors and nurses we are all familiar with the process of walking a precarious rim of need without being consumed. I must admit this time I have more difficulty, and I am left numb and emotionless for a time. Our team is strong though – everyone encourages everyone else and laughter begins to help us through our other emotions. 

We complete a mandatory debriefing with H2H counselors. Out for one last supper together, home and in bed by 11. 

Day Five… Home again – what now? 

Team departs Chengdu after meetings and planning sessions with H2H staff and directors. HOPE has committed to long-term repeated trips, so we arrange some things for the next team. We encourage more focused involvement at one or two areas and less fact- finding or exploratory work. We discuss community building processes – involvement of all in the process – medical, kid’s workers, counselors. We encourage H2H start doing community “assets assessments” in addition to identifying the needs. 

Back to airport – delays again. Home by 10:30P. 

Debriefing meeting is scheduled for Sunday with a follow up team already ready to depart on Tuesday. Everyone has returned safely but exhausted. The needs in Sichuan are completely overwhelming and we hope we have been able to provide something of value to the suffering people there. 

Click here for HOPE’s Sichuan Earthquake photostream… 

Please click here to contribute to HOPE’s disaster relief teams. Enter “Place Special Projects” in the comments area.

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