Death After the Typhoon: ‘It Was Preventable’
Jes Aznar for The New York Times
Marycris Pulga beside the body of her husband, Richard, at a hospital in Tacloban, the Philippines.
By KEITH BRADSHER
Published: November 15, 2013
TACLOBAN, the Philippines — Richard Pulga lay on a hard steel gurney for five days with only a saline drip after being seriously injured in the typhoon that devastated his country.
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Related
Relief Proceeds Slowly in Philippines, Where a Death Toll Remains Unclear (November 16, 2013)
Responding to a Typhoon on the Web (November 16, 2013)
The Lede: How to Help Typhoon Victims in the Philippines(November 11, 2013)
Mr. Pulga on Wednesday.
On Friday, Mr. Pulga, 27, died — essentially of a broken leg.
Doctors said the father of two small children could have been saved. Instead, he became a victim of the incompetence and inaction that have plagued relief efforts here for the hundreds of thousands left injured, or homeless or hungry, and sometimes all three, since the typhoon hit.
By the time Dr. Rodel Flores, a surgeon with a team of visiting doctors, found Mr. Pulga on Thursday, he had received no antibiotics or antiseptic and his leg was badly infected. The doctor ordered an emergency amputation to try to save his life. But the surgery was too late, and death soon followed.
“In short,” Dr. Flores said, “it was preventable.”
Mr. Pulga was one of the first victims of Typhoon Haiyan to be brought to the top government hospital in the city. He was there because he had tried to protect his home, sending his family to a safer place as some of the highest typhoon winds ever recorded slammed into his island. Those winds sent a coconut rocketing through the darkness into his leg, shattering it.
His death is one of the clearest signs yet of the human toll taken by a slow and troubled relief effort since the typhoon swept ashore on Nov. 8. Like much-needed water and food, medicine — including antibiotics — was held up for days as rescue teams struggled to operate amid the chaos of a city with too few military or police officers to provide security and too little government control.
Aid workers huddled for days at the airport, unable to obtain vehicles or fuel and fearful of venturing out amid reports of sporadic gunfire as desperate people nearly hijacked one convoy approaching Tacloban, which turned back. Some of those workers have since said the inadequate government response has made this disaster more difficult in some ways than such historic catastrophes as the Indian Ocean tsunami in 2004.
By Friday, a full week into the disaster, aid had finally begun to flow more smoothly, in part because of help from better-equipped foreign militaries. Field hospitals had begun to be set up, but as with the Indian Ocean disaster, aid workers worried that infections from lacerations would claim many more lives.
For Mr. Pulga’s family, the loss is catastrophic. A farmer, Mr. Pulga was one of the few men in his extended family able to earn money. In his final days, as he spoke with a reporter from The New York Times, it was that thought that consumed him.
On Friday, his widow, Marycris, wept next to his covered corpse in a hallway at St. Paul’s Hospital here, a private hospital the surgeons transferred him to in the last-ditch effort to save him.
After initially being too traumatized to visit, she had arrived in time for his surgery.
“I want to bring him home,” she said Friday, “but we have no home left.”
Mr. Pulga arrived at the first hospital, Eastern Visayas Regional Medical Center, shortly after the storm swept through.
The hospital had been partly swamped with seawater, losing electricity and most of its medical supplies. In his time there, Mr. Pulga received virtually no care.
When his wound began leaking blood during the interview on Wednesday, two workers in orange Philippines Department of Health vests removed the blood-caked, four-day-old bandage, showed the wound briefly to a government doctor, then secured the same bandage with gauze to stop the bleeding.
The hospital was running low on antiseptics, antibiotics and painkillers; Mr. Pulga received none. It was unclear why the hospital’s triage team did not make him a higher priority.
Luminada Florendo, Mr. Pulga’s aunt, said on Wednesday that a doctor had suggested she take him home because she had no money for the treatment he would need; the doctor left before he could be interviewed.
When the visiting medical team from Davao in the southern Philippines showed up a day later, the doctors concluded that Mr. Pulga was the sickest person in the hospital and ordered that he be transferred to St. Paul’s. Dr. Mauri Bravo III, one of the surgeons who performed the amputation, said the wound had a distinctive fruity smell of infection. Mr. Pulga’s eyes were turning yellow, and his abdomen was distended. Doctors found no sign of lower-back injury, another possible cause of abdominal pain.
Virginia Ausa, a nurse at Eastern Visayas Regional, said that no one there had been aware that Mr. Pulga had been interviewed by an international news organization and that he had not been singled out for special treatment for this reason by the Davao team. Dr. Flores said the same.
Multimedia
Related
Relief Proceeds Slowly in Philippines, Where a Death Toll Remains Unclear (November 16, 2013)
Responding to a Typhoon on the Web (November 16, 2013)
The Lede: How to Help Typhoon Victims in the Philippines(November 11, 2013)
As the doctors prepared Mr. Pulga for surgery on Thursday, it became clear that he was suffering from septicemia and that his body’s ability to produce red blood cells was dwindling.
But on Friday his body began to shut down, partly because the hospital’s blood bank had been destroyed, so he could not receive a needed transfusion before surgery. By late morning, he was dead.
Dr. Flores said the bill for his care would most likely be covered by the Philippines Department of Health.
When told the story of Mr. Pulga’s final days, Mayor Alfred S. Romualdez — who has been widely accused by residents of mounting an insufficient relief response — was quick to deflect criticism, saying Eastern Visayas Regional has long been “a problem.”
Dr. Albert de Leon, the hospital’s chief administrator, said malnutrition and other unsuspected weaknesses in people like Mr. Pulga sometimes made them hard to save. “There is a supreme being who decides the fate of every one of us,” he said.
When told of Mr. Romualdez’s criticisms, Dr. de Leon launched into such an angry outburst that another doctor rushed over to calm him. Dr. de Leon said that his hospital was an excellent teaching and research institution and that the mayor should do much more to organize typhoon relief.
“We are in his city, and yet he is not doing that — even the garbage disposal, he doesn’t do anything,” Dr. de Leon raged in a hospital corridor that was growing dark at sunset and still had no electricity.
At St. Paul’s Hospital, a security guard told Mr. Pulga’s wife that her husband’s body would have to be buried in a mass grave if she could not remove it. She had no vehicle to transport it and sobbed for more than an hour, refusing to make a decision.
Dr. Flores and Dr. Bravo gave a lengthy interview in the hospital parking lot about Mr. Pulga’s last days. Dr. Bravo then went upstairs to the steel bed where Mr. Pulga’s body had been.
It was empty. No one seemed to know where the corpse or the bereaved had gone.
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