Long before first light we were up and at it, clearing debris, using an avalanche shovel to move sodden piles of paper, broken glass, pieces of shattered furniture, air conditioners, and computer equipment. It was Monday morning, Tanauan Town Hall, Leyte Province, Philippines, 72 hours after landfall of the most formidable cyclonic storm ever recorded. There was no roof on the building. We'd been traveling for three days. We'd promised the locals that we'd have a fully functioning field triage hospital with three operating rooms up and running on the second floor by 0800 hours.
The Office of the Registrar became the main supply room and pharmacy, mostly because it had a door that could still be locked even after team leader Mike Karch and Mike McMahon, one of our ortho techs, had broken into it using a Leatherman. Somebody from the mayor's office later provided the key. As gingerly as we could, we moved aside soggy, molding stacks of birth certificates and death certificates and marriage licenses. We cleared shelves, pushed desks together, stowed wet laptops in desk drawers, and began to unpack our supplies and equipment. We found a couple of sponge mops to move the slosh around. And brooms of a sort, made from palm fronds already thick with mold.
The Town Council chambers became the main operating theater. Somebody found a long pole that served excellently for lancing ceiling panels to drain standing water. We collected the stuff in buckets for Jon Bourne, anesthesiologist and self-appointed latrine master, to use for cleaning and flushing toilets. "If Jon hadn't done that, we'd all be sick or dead," said Wayne Anderson, another of our anesthesiologists, in retrospect. Wayne meanwhile stood on a desk and pried off panels from the ceiling above the center of the room. We used the panels to plow debris and water out into the hallway and from there down into the newly dubbed waiting room below. The locals pushed it from there out into the street. Desks became operating tables, covered with sheets of heavy architectural plastic someone had found in one of the offices. Large overturned bookshelves in the back room served as recovery beds.
Karch and Paul Chu (our third anesthesiologist) used duct tape to affix a small flagpole to the window grating in the council chambers, hanging the national flag out over the street. It seemed the right thing to do. Maybe it would help restore faith, boost morale, inspire civic sanity. Dozens of people were already gathered outside, lined up peacefully in the early light, watching us, waiting for things to get started. Contrary to the media's tendency to highlight chaos and violence after natural disasters, academic research indicates that social cohesion tends to increase and crime rates tend to drop in the wake of such events. Still, it became evident that Town Hall, such as it was, between our presence there and the unflagging energies of the medics and nurses and municipal staff downstairs, had come to represent a fairly convincing case for law and order, one that seemed to have a ripple effect on the greater population. There were demolished hospitals in Tacloban that had already been or would soon be relieved of their supplies and a mall that would get pilfered; in the town of Guiuan, where the storm had first made landfall, the mayor felt he had no choice but to legalize the commandeering of supplies from shops whose owners had escaped to Manila. We saw nothing of the sort in Tanauan.
The Planning and Development Office became the labor and delivery room. The local midwives brought their patients upstairs to where they could at last find some peace and privacy. (The following day a third midwife would show up to work. Her name was Golda. She'd lost her own four-year-old daughter in the storm surge.) A pair of local kids, camped out with their family in the Agriculture Office, helped scoop out some of the muck in exchange for a gallon of hand-filtered water and some of the stash of Halloween candy brought by Carson Bold, the 16-year-old son of one of our physician's assistants. Our hands grew soft and mushy. We wore gloves, as much as possible, to keep from getting cuts. Cuts meant infection. I already had a small one under way in my right eye, the product of some tiny stinging insect my eyeball had run into on the previous night's virgin run to the well, which offending object Karch had pulled out with his fingers. Before and after we touched pretty much anything, we washed our hands obsessively with hand sanitizer and, when that ran out, in a day or two, with alcohol.
On the landing at the head of the stairs, Dr. Sara May established a pleasant intake office and triage lounge using a bamboo screen featuring sun-faded Tanauan skimboarding photos and a pair of indestructible potted plants she'd scavenged from the wreckage. It wouldn't last but that one first day—when the rain kicked in again we'd have to tighten up the ship—but it gave everybody a point of reference for the way things ought to be. By 0600 hours a hot sun was shining through the rafters, drying out the ceilings and floors and making life seem not just possible but downright delightful. After a quick breakfast meeting (600 calories per person—meatballs with marinara sauce? pork sausage with gravy? sloppy joe? apple sauce, crackers, grape jelly), I put in a request with the army guys and also with the mayor's people for tarps of some kind so we could get some shade on our patio and in the O.R. Alan Podawiltz, our handyman, and Carson began a nonstop regimen of pumping water, liter after liter after liter, for us to drink and for cleaning wounds in the O.R.