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Dead of a Failed Relief Effort, as Much as Typhoon’s Winds Death After the Typhoon: ‘It Was Preventable’
(about 3 hours later)
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.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.
On Friday, Mr. Pulga, 27, died — essentially of a broken leg.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, homeless, hungry and increasingly desperate since the typhoon hit. 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, the senior surgeon on a team of visiting doctors, found Mr. Pulga Thursday, he had received no antibiotics and his leg was badly infected. The doctor ordered emergency surgery to remove the limb and try to save his life. But it was too late. 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.”“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 wife and children to a safer place as some of the highest winds ever recorded slammed into his island. Those winds sent a coconut rocketing through the darkness into his leg, shattering it. 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 Typhoon Haiyan swept ashore last Friday. 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 to provide security and too little government control.Aid workers huddled for days in the airport, fearful of venturing out amid reports of sporadic gunfire and after at least one convoy was raided by desperate people. Some of those workers have since said the inadequate government response has made this disaster in some ways more difficult than such historic catastrophes as the Indian Ocean tsunami in 2004. His death is one of the clearest signs yet of the human toll taken by a slow and troubled relief effort since Typhoon Haiyan 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 to provide security and too little government control.
By Friday, a full week into the disaster, aid had finally begun to flow more smoothly, at least into Tacloban, in part because of help from better-equipped foreign militaries trained to deal with natural disasters. 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. 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 consumed him.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 consumed him.
On Friday, his widow, Marycris Pulga, 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. 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 by the storm to visit, she had arrived for his final days. After initially being too traumatized to visit, she had arrived in time for his surgery.
“I want to bring him home,” she said, “but we have no home left.” “I want to bring him home,” she said Friday, “but we have no home left.”
Mr. Pulga arrived at Eastern Visayas Regional Medical Center shortly after the winds whipped up a wall of water that flattened much of the city. 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, and it lost its electrical supply and most of its medical supplies. In his time there, Mr. Pulga received virtually no care. 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 an interview on Wednesday, two health 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. 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, and Mr. Pulga received none. It was unclear why the hospital’s triage team had not assigned a higher priority to him from the start. 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 the doctor had suggested she take him home because she had no money for the extensive treatment he would need to recover; the doctor left before he could be interviewed. 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, they concluded that Mr. Pulga was the sickest person in the hospital and ordered that he be among 15 patients transferred to St. Paul’s Hospital. Dr. Mauri Bravo III, one of the surgeons who performed Mr. Pulga’s amputation, said the wound had a distinctive fruity smell of infection. Mr. Pulga’s eyes were turning yellow and his abdomen was distended. 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 was not singled out for special treatment by the Davao team. Dr. Flores said the same. 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 was not singled out for special treatment for this reason by the Davao team. Dr. Flores said the same.
As the doctors prepared Mr. Pulga for surgery Thursday, it became clear to them that he was suffering from septicemia and that his body’s ability to produce red blood cells was dwindling. As the doctors prepared Mr. Pulga for surgery Thursday, it became clear that he was suffering from septicemia and that his body’s ability to produce red blood cells was dwindling.
The hospital has lost all its blood supply in the storm, and without equipment to test for blood compatibility, the doctors decided to amputate without a transfusion. Initially it appeared the gamble worked as Mr. Pulga’s white blood cell count began to decline slightly, possibly a sign of reduced infection, Dr. Flores said. 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.
Mr. Pulga even regained full consciousness, but on Friday his body began to shut down. By late morning, he was dead. Dr. Flores said the bill for his care would likely be covered by the Philippines Department of Health.
Dr. Flores said he did not think Mr. Pulga’s family would be billed for the failed attempt to save his life because it should be covered by the Philippines Department of Health as part of its response to the typhoon. When told the story of Mr. Pulga’s final days, Mayor Alfred 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.”
When told the story of Mr. Pulga’s final days, Mayor Alfred Romualdez of Tacloban — who has been widely accused by residents here of mounting an insufficient relief response — was quick to say that his death was not the result of a bungled relief effort. He instead criticized Eastern Visayas Regional hospital, saying it 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.
Dr. Albert de Leon, the chief administrator of the hospital, said that he was aware of Mr. Pulga’s death, but that 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.
“There are some things beyond the limits of medical knowledge,” he said. “There is a supreme being who decides the fate of every one of us.”
When told of Mayor 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.When told of Mayor 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.“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 removed. She tried frantically to reach relatives now that sporadic cellphone service in some places has returned, but she was unable to find one with a vehicle. 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.
The security guard said the body would need to go into one of the mass graves for typhoon victims. Mrs. Pulga sobbed for more than an hour and refused to make a decision. 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. Then they went back upstairs to the gray steel bed where Mr. Pulga’s body had been lying. 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.It was empty. No one seemed to know where the corpse or the bereaved had gone.