Paper for the Workshop on ‘Disaster Management for the Health Sector in Indonesia’,
Bali Padma Hotel, Kuta, 11-13 Juni 2003

VOLUNTEER ASSISTANCE AT SANGLAH HOSPITAL
AFTER THE KUTA BLAST (12-10-2002)

7. Morgue

   Facilities at the hospital morgue - sufficient under normal circumstances because the family usually takes a deceased relative home immediately - were totally inadequate to cope with a disaster of this size¹⁰. All remains of bomb victims were brought to the Sanglah morgue on Sunday. Because of lack of space inside the building, most remains were put in the open corridor connecting the morgue with the other buildings of the hospital on the tiled floor and cement sidewalks. A temporary fence was erected to seal the site from view. On Sunday night a liquid disinfectant was sprayed on the bodies (by the Australian Federal Police?). To keep the corpses as cool as possible, blocks of ice were but in between. It took approximately 40 hours after the disaster before something could be done about this situation.

   A pressing need at the morgue was to obtain facilities for freezing storage of the remains of the nearly 200 victims (cooling turned out to be needed for a longer period as the process of identification took months). One thermo-king was standing in the yard outside the morgue building (where from not known to the writer). A private person offered the hospital to organize more cooling through his network on Sunday evening¹¹. On Monday at 16.00 two 20 feet cooling containers arrived lend by a private company in Bali and at 18.00 another thermoking organized by a community organization. Fortunately the yard in front of the morgue was sufficiently large. An hour before the cooling containers arrived, body bags from the Indonesian and Australian governements came in on Monday, so early in the evening the loading of bodies in the containers was started. Coffins were available¹², donated too, and the bodies were first put in these before lifted into the containers. However, because the coffins quickly filled the available space. Therefore the bodies were taken out of the coffins again and stacked in the container in their bags, so more bodies could be cooled.

   Related to cooling is ice. Huge amounts of blocks of ice and 'dry' ice were used to cool the bodies before the cooling containers came in on Monday and ice continued to be needed afterwards because part of remains could not be stored in the cooling containers. Costs for ice were born by a community organization and private persons (and later by government funds as well?) Ice was not always delivered on a timely basis over the days and weeks to follow.

   On the first days volunteers involved themselves in identification work. For example on Sunday night (03.00-04.00 in the morning) when morgue personnel had gone home, a number of volunteers continued making notes and taking pictures with a digital camera. The intention was good: to speed up identification and disseminate it through the internet as soon as possible. However, due to lack of coordination 'bodies got mixed up' in following days, causing intense frustration on the side of professionals and volunteers alike.

   Worker sustenance was insufficient: plastic gloves, boots (Sunday night a few centimeters of watery fluid surrounded the bodies), buckets to clean, disinfectant soap, and so forth. Items that could be bought were bought right away at the nearest supermarkt by community organizations and private individuals. For washing hands, feet and cleaning the place, it is advised to place a number of taps outside the building for easy access. (Moreover available material for identification of bodies was not functional. The available carton labels became wet and the writing on it smudged. Needed are plastified labels, small bags for property items to be kept with the body).

   Easy access to the morgue was also given to family members looking for relatives on following days. Nothing could have stopped them doing so anyway (unless information on procedures is handed out and appropriate security measures are taken).

   In order to assist the hospital stabilizing the situation at the morgue, security was stepped up, so after the first days entrance by the public became more regulated. After the first week only selected volunteers were allowed to come to the morgue and work there.

   Recommendations: make provisions for hiring or purchase of additional freezing/cooling facilities from an appropriate government institution or private company (including technical assistance for maintenance). Provide for a standing agreement with an ice factory and/or provider of dry ice in case of disaster to enable speedy action and regular delivery. Assign sufficient extra staff to the morgue in case of crisis. centralize work on identification of bodies from the very start with only professional hospital and health department officials. Store items for identification and worker sustenance at a specific place or provide for immediate delivery from a previously known supplier / depot. only allow volunteers in the morgue under supervision and with clearly defined tasks. contemplate a strict entrance policy and security measures to enforce it.

   
   

   10 Sanglah’s Hospital Director Dr. Lanang Rudiarta revealed this problem on a television broadcast at noon on Sunday. 11 At first a fixed container of a private company was contemplated but mobile containers were more practical as these could be stationed at the hospital, facilitating identification work. 12 Apparently storing of bodies was also on the mind of others. Tens of decorated wooden coffins were donated by a private company and a pile of simple plywood ones were available as well. However, due to the need for time consuming identification these donations turned out to be less functional.

   Ante mortem administration. The number of official hospital staff at the morgue was too small to provide the necessary services to the large amount of people making enquiries and wanting to go inside. Probably a language problem also played a role. A number of volunteers stepped in and assisted families and consulate personnel to fill in a form with data on the person looked for and accompagnied them into the morgue. Unfortunately a system of communication and exchange of data between volunteers and hospital staff did not develop. Most data were brought back to the hotline and processed there.

   Post mortem procedure. Families were confused about post mortem procedure and did not always understand why the body of a relative could not be taken immediately. They asked volunteers, because the morgue personnel who would have had time under normal circumstances, was too busy. However, volunteers did not know the procedure. Because of questions from bereaved family members, the procedure for the release of a body based on verbal information of one of the doctors at the morgue was typed out by a volunteer on Tuesday in Indonesian, next day translated into English, copied and distributed at the morgue, crisis centre, hotline and sent to consulates.

   Recommendations: Ensure that Proper Interpol forms (or other standard forms) are available for ante-mortem data from the very beginning. produce an information sheet in various languages with the procedures to be followed at the morgue (not only on release of body but including procedure for going inside). Prepare a reception desk with sufficient personnel (including persons fluent in foreign languages if necessary). ensure that the reception space is sufficiently large (or can be easily enlarged or replaced) and that there is a single –easy to seal off – entrance to the interior. ensure that hard ware for data processing is available on the spot. ensure that staff and volunteers process their data on the spot.

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