`Mercy' fulfill a patient's wish

Chisato Hara, The Jakarta Post, aboard the USNS Mercy, Nias

Laia Temazatulo is 23 years old, but he looks as though he is middle-aged, with a thin frame and exhaustion apparent on his pale face.

Laia suffered a minor injury during the March 28 earthquake on Nias, West Sumatra, when he was hit in the left flank by a falling beam. Three weeks later, however, he had developed a 10- centimeter abscess where he had been injured, lost 30 kilograms and was experiencing difficulty breathing and urinating.

Alarmed at his condition, his brother-in-law drove him on a motorbike down to the main hospital in Gunung Sitoli for treatment. But the wards were full with hundreds of injured quake victims, so hospital administrators contacted the USNS Mercy hospital ship, which was anchored off the coast of the island.

The USNS Mercy is a floating hospital operated by the U.S. Navy's civilian branch, the Military Sealift Command, and primarily provides humanitarian medical assistance in conflict and disaster areas. While the ship is manned by a civilian crew, its doctors and nurses are all Navy medical staff.

For its Nias operation, in addition to almost 500 Navy medical and support personnel, the Mercy was also staffed by about 50 medical and health care professionals from Project HOPE, a non- governmental organization that provides emergency medical assistance and health education.

Laia was evacuated to the Mercy on April 17 by helicopter, and upon admittance to its casualty receiving center, doctors diagnosed that he was suffering from acute, chronic renal failure.

Further tests, including a CAT scan, showed that Laia's right kidney was malformed from birth and was filled with stones, while his left kidney was non-functional from a rare infection called xanthogranulomatous pyelonephritis, or XGP. The infection had spread to the muscles behind the kidney and had formed an abscess.

"Laia basically had a week to live when he came to us," said US Navy urologist Dr. Jim L'esperance, who was added to the Mercy's medical personnel manifest the day before the hospital ship arrived at Nias.

When Laia was told his chances, he immediately insisted on being returned to Nias -- if he was to die, he wanted to die among friends and family.

The Mercy's doctors explained that his chances might improve with treatment, which would involve first draining the abscess and, depending on his condition, surgical removal of the infected kidney.

It was Project HOPE nurse Emily Olmstead who finally got through to Laia, and convinced him to agree to the initial treatment -- and 2.5 liters of pus and other fluids was drained from the abscess.

Two days later, Laia had shown "a remarkable change in health", said L'esperance, so they raised the surgical option. "It was then that social concerns became an issue," he said.

Laia explained that his wife of less than a year had just given birth to their first child after the quake, and again insisted on returning home to die.

Usually, a family member or other "escort" would be medevacked along with the potential patient for consulting with regards to treatment options, but Laia's brother-in-law had dropped him off at the Nias hospital and then returned home, and was unaware that Laia had been taken to the Mercy.

An effort was made to locate his family, but they could not be contacted, and Laia made the decision to undergo the operation.

"The special relationship Laia formed with Emily was simply amazing -- he wouldn't accept anything unless she offered the option," said L'esperance.

The surgery was successful, and Laia's condition stabilized enough for him to go home.

The International Organization for Migration (IOM) team organized the return of medevacked Nias residents from the Mercy -- as well as from Medan hospitals. When the team arrived onboard the ship on April 28 to take Laia back to Nias, they found Olmstead speaking quietly to him as he lay on his hospital bunk.

After greeting the IOM team, Olmstead said, "Now, if you'll excuse me, I have to get my patient ready. Please give us a few moments."

A wheelchair was provided to transport Laia to a stretcher, and encouraging him gently but firmly, Olmstead got him out of bed and walked him to the wheelchair, leading him by both hands and praised him as he shuffled slowly to the chair. In response, Laia broke out into a small, tentative smile.

As a US Navy nurse escorted Laia to the next level up, where another team secured him onto a stretcher for the helicopter flight back to the island, Olmstead assembled his discharge papers, and Capt. David Llewellyn, Commanding Officer of the Mercy's Medical Treatment Facility, approached the waiting IOM team.

"The IOM has been great in getting these patients back home," Llewellyn said, shaking hands all around.

A flight crew member strapped a regulation helmet on Laia, then he was loaded on to the waiting SeaHawk helicopter and flown home, accompanied by L'esperance, Olmstead and the IOM team.

Upon arriving in a football field that served as a makeshift landing site, Nias-based Navy personnel carried Laia to a waiting ambulance provided by the local health office, which would take him the final leg of his journey home. Olmstead said her goodbyes to Laia while instructing ambulance staff to be careful, and boarded along with the others on a separate van to return to base camp Pedopo in Gunung Sitoli.

During the short ride to camp, she sat in silence to the rear of the vehicle, gazing out of the window at Laia's ambulance until it was out of sight.

"Laia's got a 50-50 chance at life now," said L'esperance. "He made his intentions very clear from the beginning. He wanted to go home -- we got him home. I'm content that we did all we could for him."

Laia was one of the last dozen patients to be released from the Mercy, which raised anchor on April 29 and headed home to San Diego, California, after nearly five months at sea in Aceh and Nias.