This is a personal “From the Field” story by Direct Relief Employee Annie Maxwell and Emergency Coordinator Brett Williams.

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.