Direct Relief International Sends $1.7 Million Worth of Emergency Medical Aid to Java

Direct Relief International this week provided two of its earthquake relief partners Australian Aid International (AAI) and CHF International with $1.7 million (wholesale) worth of medical material aid. The four tons of medical material was flown to Indonesia on Tuesday, June 13 and will be distributed on Thursday, June 16 in Indonesia.

In response to the changing medical needs of earthquake survivors in Yogyakarta, an emergency shipment of pharmaceuticals, nutritional supplements, and medical supplies was air freighted to earthquake relief partners Australian Aid International (AAI) and CHF International. Communication received from Direct Relief staff members, who have been on-site assessing the situation, directed the decision on shipment priority and contents.

Direct Relief's Emergency Coordinator reported from Yogyakarta that there had been a shift in the majority of earthquake-related injuries from orthopedic problems to rehabilitation, lacerations, and skin infections primarily as a result of villagers attempting to excavate their homes. Upper respiratory infections are also a major concern due to the compromised living conditions as well as ash and smoke generated from the nearby volcano that continues to threaten a larger eruption.

The earthquake response from AAI has been extensive. AAI physicians took over a field hospital established by a departing organization, and are providing medical services to hundreds of earthquake survivors. Products provided to AAI included a variety of anti-infective agents to address infections due to dirty wounds, upper and lower respiratory illnesses, and gastrointestinal problems; dermatological products to address fungal infections and skin irritation and rashes; and first aid and general hospital supplies for consultations, minor injuries, vaccinations, and rehydration.

Product designated for CHF included antibiotics, prenatal supplements, gastrointestinal agents, and assorted first aid and orthopedic supplies. CHF had previously received a Direct Relief emergency shipment in response to the earthquake. Working with Persatuan Perawat Nacional (PPNI), an Indonesian partner organization that deployed a team of 20 nurses to Yogyakarta to care for earthquake victims, CHF distributed donated medical goods to local health posts, medical clinics, and hospitals.

The following companies donated products specifically requested for the Indonesia earthquake that were included in this shipment:

• BD
• Johnson & Johnson
• Merck & Company, Inc.
• Pfizer Consumer Healthcare
• Schering-Plough

Direct Relief responded immediately after the earthquake in providing both emergency cash grants and medical material aid to Indonesian-based partner organizations and colleague U.S. nongovernmental organizations with medical teams in the region. Cash assistance went towards purchasing two ambulances, supplies and equipment to equip its eight field-based clinics (minor surgery sets, sterilizers, suction, disposables, etc.), eight small generators to power the clinics, along with providing financial assistance for teams of nurses and doctors to medical support, nutrition, and address other urgent needs for those affected by the earthquake.

Indonesia Earthquake Assistance Update

Chief of Staff Annie Maxwell and Emergency Coordinator Brett Williams reported from Yogyakarta today the increasing anxiety on the ground over whether Mt. Merapi will erupt. Yogyakarta is 30 km (18.6 miles) away from the Merapi, while Bantul which was the epicenter of the quake is 35 km (21.7 miles) away. The mountain's lava dome has swelled, raising concerns that it could suddenly collapse, sending scalding clouds of fast-moving gas, lava, and rocks into still-populated areas. They also reported continuing seismic activity in the area with hundreds of aftershocks, including a 3.5-magnitude trembler on Friday and a similar one on Thursday that further complicates the relief efforts.

The dynamic of one disaster possibly overwhelming the current emergency response has been discussed considerably between the NGOs on the ground and the Indonesian government and military. The Indonesian government has encouraged the surrounding villages along the slopes of Merapi to evacuate to interim shelters and camps where they reside at night and are allowed to return to their homes during the day.

Maxwell and Williams also reported a shift in the majority of earthquake-related injuries from orthopedic problems to rehabilitation, lacerations, and skin infections from villagers attempting to excavate their homes. Upper respiratory infections are also a concern due to the ash and smoke generated from the volcano.

Direct Relief staff members had the opportunity to visit one of its local partners, PKPA, on Thursday. One week following the earthquake, affected children need psychological recovery program and emergency education program. The emergency education is needed until formal education in the affected areas can run under normal situation. Poor sanitation in the affected areas and lack of nutritious foods are believed to be one of the contributing factors for disease spread among the children.

PKPA is an Indonesian organization focused on children’s rights and health, and Direct Relief is financing three of its health programs in Aceh and Medan in Sumatra as part of the tsunami recovery effort.

PKPA’s executive director, Mr. Ahmad Sofian, is in Yogyakarta conducting a rapid health assessment. Direct Relief approved cash support within 72 hours of the quake to enable PKPA to send 10 physicians to Yogyakarta to provide medical support, nutrition, and address other urgent needs for affected infants and children.

According to PKPA, urgent activities in the affected areas include:

• Establishment of child information center in both Central Java and Yogyakarta to coordinate special activities and needs for children;
• Establishment of emergency or temporary schools to return children to school and psychosocial programs for children in rural areas;
• Provision of additional/nutritious foods for children aged between 0 – 12 years;
• Protecting children from commercial sexual exploitation of children in emergency situation.

PKPA is planning to implement these programs in the sub districts of Gantiwarno and Wedi, the district of Klaten and in the sub district of Bambanglipuro, the District of Bantul.

To obtain more valid data about the status of children in these three areas, PKPA is currently coordinating with various parties and is conducting rapid assessments at the sub district and village levels.

Situation Report from the Field

Chief of Staff Annie Maxwell and Emergency Coordinator Brett Williams filed the following report from Indonesia:

The Indonesian people have responded to the tragic loss of life and extensive displacement with tremendous resolve. Our arrival in Yogyakarta three days ago coincided with the arrival of the emergency medical shipment that had been packed and air-shipped.; Clearance of the material went smoothly and Muhammadiyah had already cleared the material and trucked it down to their hospitals in Bantul and Yogyakarta.

The official reports from WHO indicate that 6,487 people have been killed by the earthquake and that approximately 96,000 persons have been injured. Property damage in along the fault line is extensive, with an estimate of between 200,000 and 650,000 people left homeless.

Despite the extensive damage at the epicenter and along the fault lines, the airports in Solo, Yogyakarta, and Jakarta are all open and functioning, and the main roads from Jakarta are clear.; The transportation channels for medical and other relief supplies from main commercial hubs are open, adequate warehousing for re-supply as may be needed, and basic communications infrastructure are all working, which is helpful.

Trauma cases due to falling debris caused both a surge in surgical cases – with over 4,200 being reported by the WHO – and basic wound care.

Muhammadiyah, the Indonesian civic organization with which we are working, operates two hospitals in the region, both of which received 1,000 patients on day of the earthquake.; Muhummadiyah also has converted three additional sites, in a bank, a school, and a women’s center, to health facilities, that are being staffed by a combination of Muhammadiyah health professionals redeployed from the organization’s other facilities and government facilities.

Muhammadiyah is also mobilizing 5 to 10 physician led teams each day to travel to outlying villages to provide services to people who are either unable or unwilling to leave their villages.; Early reports of looting when people departed their homes have apparently made many people reluctant to relocate for services, and patient transport is a challenge.

With funds received from Amgen, Direct Relief was able to purchase two ambulances for Muhammadiyah to replace those that were lost in the quake.; The vehicles are being outfitted and will be handed over within the next few days.

While Indonesian citizens and government and military personnel are doing most of the work, the international response is visible.; To ensure coordination, we have registered with the UN office established and have attended the health cluster meeting to share what we have learned, where our efforts are being focused, and what we have learned.

The response from Australia’s official aid program and from the private group Australian Aid International (AAI), with whom Direct Relief is working, has been extensive. AAI physicians have taken over a field hospital established by another organization that has departed, and the physician directing the site has prepared detailed needs lists that we are working to fulfill.

Concerns exist about tetanus, several cases of which have been confirmed.; We learned that adequate supplies of the vaccine are in the theater and its distribution will be managed by the Government of Indonesia and WHO.; Direct Relief will not play a role in this issue.

While overall supplies seem to be adequate and the overall response generally working smoothly, gaps do exist.; Providing services to outlying villages likely will be handled by a combination of field clinics and outreach teams, with transport and personnel needed.; Water and sanitation, always a concern, is also a challenge, but UNICEF and the Government appear to have a good plan and coordinated effort underway with water trucks and portable toilets.

Upper respiratory infections brought on by exposure during the rains and potentially by fallout from the Mt. Merapi volcano which is very active, are areas of potential concern.

We are working on specific surgical kits for orthopedic cases based on input from surgeons.; We also have forwarded offline an extensive list of basic needs that will require re-supply and assistive devices for people who have lost limbs or are injured.