Sichuan, after the quake: Setting up a field hospital

Dr. Giorgio Cortassa arrived in Sichuan on May 17, five days after China’s strongest earthquake since 1976 hit the region. He helped rescue victims in a field hospital about 80 kilometers from the quake’s epicenter. 

The 7.8-magnitude temblor came May 12 at 2:28 p.m. local time, and shook the Wenchuan county in the Aba prefecture, about 80 kilometers northwest of Chengdu, the capital of China’s Sichuan Province.

Cortassa reached the airport in Chengdu late on May 17, after his plane was held up on the Beijing runway for two hours.

“We didn’t know if we would ever take off,” he recalled. “While waiting, eventually I called a colleague, a nurse in Chengdu, and he told me there were rumors that the dam in Beichuan was about to collapse.”

Cortassa still doesn’t know if that was the reason the flight was delayed. But the fear of an upcoming collapse of the Beichuan dam continued for weeks.

“Logistics at Chengdu airport were frenetic, the population was scared by aftershocks, refugee camps were being setup, the PLA [People’s Liberation Army] was active but with a low technical level, water supply and latrines were proving insufficient,” he said. “Approaching Beichuan, the scenario increasingly turned into a post-nuclear bomb panorama: dangerous and not totally collapsed buildings, ravines, a strong smell of decomposing dead bodies in nearly empty towns, few and shocked survivors walking around.”

Cortassa, an emergency physician, is a health project coordinator at Italy’s Development Cooperation office in China and is based at the Italian embassy in Beijing. As one of the first Italians to reach the quake-hit zones, he coordinated aid distribution and helped to set up a field hospital.

The ‘Big One’ psychosis

Cortassa arrived in Chengdu without knowing whether Chinese authorities would let foreign personnel reach the crisis areas. Joining him were Giorgio Sparaci and Carlo Giovannelli, director and project officer, respectively, of the Italian Ministry of Foreign Affairs’ local technical unit. Ambassador Riccardo Sessa, First Counselor Andrea Ferrari and Interpreter Alberto Mammarella arrived the following day to coordinate the overall rescue operations.

Once in Chengdu, they checked into the Hotel Intercontinental, which was said to withstand magnitude 8.5 quakes. A magnitude 6 tremor welcomed them.

“We hardly noticed it,” Cortassa said. “It lasted just a few seconds, but it was shocking to see this grand hall of this extraordinary hotel with columns shaking, and hearing these huge chandeliers. At first it sounded like the wind, but then, no, it was a real tremor. And everybody around was panicking.”

On May 14, three days before he left Beijing, Cortassa had seen a communiqué sent by China’s Ministry of Commerce to foreign counterparts. It specified the items China needed most urgently in the quake-hit areas.

“They were asking for sophisticated material for search and rescue [SAR] operations,” he recalled. “Things such as electromagnetic probes, sound amplifiers to identify people buried under the ruins or advanced medical equipment, which left us a bit perplexed because, well, you cannot supply somebody with a plane if they haven’t been trained on how to use it. These are things that are to be provided together with the people who know how to operate them.”

At a meeting with embassy delegations the following day, Chinese officials reiterated the need for advanced equipment and financial support, but no foreign personnel on the ground.

“This is understandable,” Cortassa said, noting that foreigners can easily be a burden for local rescuers if they do not know the area or speak the local language.

“The first rule in these cases,” Cortassa said, “is not to have to rescue the rescuers.”

On May 18, the first two Italian cargos arrived in Chengdu, carrying aid as well as medical personnel to set up a field hospital funded by the Italian government.

“Although it made sense that they didn’t want foreign staff,” said Cortassa, “at that point, we still didn’t know if it was OK that they intervene. But then the ambassador was given the green light.”

That night, a Sunday, Cortassa and Marshal Alessandro Pirrone from the emergency section of Italy’s Development Cooperation office, who was in charge of military emergency logistics, identified the most suitable zone for setting up a field hospital. Equipment had just arrived from Italy.

“As we were finishing dinner,” he recalled, “the waiter came and asked us if we could please evacuate the hotel because the ‘Big One’ was expected during the night.”

Newly arrived experts from Italy’s Civil Protection Department argued that it is geologically impossible to predict at exactly what time such a tremor would occur. Hotel guests waited in the lobby for a while before heading to bed. Many who had seen quake predictions on television took their mattresses and slept in the hotel garden - perhaps not the best idea given the high-rise hotels surrounding it.

Had he not consulted with experts from the Civil Protection Department, Cortassa said he may have taken his mattress to the garden too. Instead, he slept - badly - in his hotel bed on the 28th floor of the Hotel Intercontinental, where he was placed during the Italian ambassador’s visit.

“That night in Chengdu, there was a sort of panic - everyone on the street, cars all around,” Cortassa recalled. “There was this psychosis that the ‘Big One,’ a tremor stronger than the one in Wenchuan, was about to hit Chengdu.”

The Big One didn’t hit that night.

Operating a field hospital

The next day, a Monday, Cortassa and his colleagues woke up early to set up a field hospital in the Xiaode township, located in the Deyang prefecture’s Mianzhu county about 84 kilometers from Wenchuan. Before the quake, Xiaode’s center was home for 20,000, while the townships housed 60,000. The quake destroyed about 20 percent of local buildings. People crowded the streets.

“The location was good for a number of reasons,” Cortassa explained. “First of all, there was room to install the hospital on a wide street, in the middle of the township. A sort of square, at a safe distance from ramshackle buildings and on a plain. So, there was no need for extra work to smooth the area. It was safe, relatively safe, because these buildings were far enough not to collapse above the hospital if they fell down. And then, the area was good in terms of the potential pool of patients.”

The hospital was set up within six or seven hours, thanks to the collective efforts of hospital personnel, staff from the Civil Protection Department and the Development Cooperation office’s local technical unit, as well as locals.

“By 4 p.m., it started operating,” he said, “and we treated on average 150, 160 patients per day.”

The field hospital donated by the Italian government was what is called an advanced medical post, and had three sections: an emergency room, an operating room and a diagnosis room. AMPs are meant to treat victims in the earliest phases of an emergency before they are transferred to larger hospitals.

“Practically, though, the AMP treated anything there was to be treated,” Cortassa said.

The field hospital was run by seven Italian doctors and seven nurses led by Giuseppe Arcidiacono. The doctors flew in from a Pisa hospital’s emergency surgery unit the day after Cortassa’s arrival and were cooperating with health personnel from the destroyed Xiaode hospital and Chinese Red Cross.

The Italians trained their local counterparts and on June 4 handed over control of the AMP to local medical staff.

“Whenever possible we spoke English,” Cortassa said. “But there were cases when our personnel didn’t speak English or the Chinese were only speaking Chinese. We had an official interpreter who was available all the time.”

Volunteers arrived after local media spread the word about this Italian hospital and welcomed anyone who could speak Chinese and Italian to help. One man arrived from Beijing to volunteer; a woman who arrived from Chengdu previously ran a bar in Rome.

In addition to the interpreters and Italian-speaking Chinese volunteers, teenagers from Xiaode helped.

“Twelve-to-13-year-old girls who spoke some English were brilliantly recruited as ‘Red Crossers’ for the triage,” Cortassa said.

All in all, a language barrier existed not just between the Italians and Chinese, but also between Chinese aid workers and locals.

“When there were local farmers, for instance, it was difficult even for the interpreter from Beijing to understand them,” Cortassa said.

Another problem was the heat.

“It was increasingly hot, 37-40 degrees Celsius inside the tents at noon,” Cortassa said. “Conditioners and fans were at maximum capacity inside the field hospital, but still it was horribly hot.”

And there were only two latrines for 20,000 people in Xiaode, according to the Italian doctor.

Organized chaos

Between May 18 and 22, three Italian cargos landed in Chengdu. Many others arrived, some via Chinese military planes. Sunday morning, on May 18, for instance, saw a continuous flow of planes landing and taking off, according to Cortassa.

“It was an organized chaos,” Cortassa said.

Italian aid alone amounted to more than €3 million (US$4.8 million), and included the field hospital, medical equipment, medic and paramedic staff, as well as more than 400 highly resistant tents, 5,000 blankets, high-energy food supplies and two first aid kits that could be used for up to 20,000 patients for three months.

“We didn’t give them the material they had first requested,” said Cortassa. “But the tents proved perfect. They would have actually needed even more.”

The donations were supplied to the Sichuan Department of Civil Affairs and the Sichuan Foreign Office for the Aba county and the towns Mianyang and Deyang, where the field hospital was located. S-DOCA was appointed as the official counterpart for everything related to aid management and foreign relations.

“The aid was managed in a valid and orderly way, considering the difficulties and confusion of such a situation,” Cortassa said.

While S-DOCA had the final say on where to distribute aid, donors helped to train locals on how to use the supplies.

Cortassa was impressed by S-DOCA’s efficiency.

“They were working 24 hours per day. Excellent personnel, high nerves. In spite of too much stress and pressure, they were doing their job at their best,” he said.

Ghost cities

While in Sichuan, Cortassa visited the Deyang, Mianzhu, Anxian and Beichuan counties. The Beichuan county was among the hardest-hit areas.

“The closer you got to Beichuan, the more dilapidated the cities,” Cortassa remembered. “Anxian, for instance, was a ghost city - few people around, smell of corpses, semicollapsed and empty buildings. Sometimes, there was just the facade of a building and then nothing behind.”

Still, “75 percent” of the roads were still usable, according to Cortassa, although difficulties increased approaching Beichuan. From Xiaode to Beichuan, travel became dangerous.

Landslides and additional aftershocks worsened the situation, bringing about secondary collapses and further injuries.

The majority of pathologies Cortassa saw were infectious, including wounds, diarrhea, high respiratory infections, scabies and other skin infections. Major traumata were caused by secondary collapses due to aftershocks or because people were going inside dangerous buildings to recover belongings.

Cortassa said he came across two types of survivors.

“In the most-hit areas, people wandered among the ruins as if under a post-bombing shock,” he said.

In the villages further away from the epicenter, where most people were still alive, he sensed an “excitement of the survivor.” Still, people were “emotionally unstable, and this turned evident any time there was a tremor,” Cortassa recalled.

Access to food was not a major problem. PLA and the Chinese Red Cross had set up field kitchens at refugee camps, and local markets still offered products at reasonable prices.

Farmers were selling vegetables on the street, banks reopened and people were able to buy local items.

“I haven’t had the feeling of a financial catastrophe,” Cortassa said. “They’ve lost their house but not their money.”

But clean water and structures for sewage disposal was lacking.

“There was quite an inadequately slow deployment of water supply and latrines at refugee camps level at the time of our intervention,” Cortessa said.

The Chinese response

China’s response to the quake was good, given the size of the disaster, Cortassa said. Still, water supply and access to latrines in post-emergency situations could have been better.

Many young soldiers had very basic equipment, often not more than shovels, Cortassa said. TV images showed no cervical collars, extricators, vacuum mattresses or other technical medical devices that are commonly used for extracting victims without causing additional damages and for stabilizing multitraumatized patients on the field, according to the aid worker.

In the first 48-72 hours, he said that foreign help could have been beneficial in providing high-tech superspecialized search and rescue teams and devices such as an advanced medical post.

PLA’s field kitchens and mobile infirmaries were good. Communications were in good condition, thanks to a prompt PLA response, and mobile phones were working from the first day Cortassa arrived. Field military hospitals were very basic, according to reports of his colleagues.

Cortassa reckoned that local communities (especially schools and hospitals) would highly benefit from access to advanced anti-seismic construction techniques, rehabilitation for the disabled (especially for those with a leg or arm prosthesis), care for orphans and lonely elderly, as well as psychological support for children. Cortassa also stressed the importance of restoring cultural heritage and preserving the environment.

Weeks after the quake, priorities included building latrines, improving water supply and avoiding further casualties as well as secondary collapses of semidestroyed infrastructure.

“In the midrun, there could be long-lasting damage to the environment and cultural heritage, economic losses, psychological scars and a high percentage of physically or psychologically disabled persons,” Cortassa cautioned.

Cortassa left Sichuan on May 27, after 10 days on the ground. A week later, he returned and reported that rescue and development initiatives were bearing fruit. Prefabricates were being quickly rebuilt, replacing tents and plastic sheetings. The refugee camps were better organized. But access to latrines and clean water was still lacking.

As of June 8, about 70,000 were reported dead, 373,000 injured, 5 million homeless and 18,000 still missing.