I am sitting in the operating theatre tent of my Australian Field Hospital.
As I look around me I see incredibly professional standards in an environment where such standards are so difficult to apply. We are operating in an air-conditioned tent no more than 500m from Tacloban Airport, the sound of multiple Hercules aircraft a continual presence in the background. Even under cover, as we are now, we occasionally have to shout to be heard. To my front is Annette, a surgeon from Darwin. She is cutting away dead tissue from the feet of a local official who has lacerated both soles as he ran for his life during the typhoon. Annette herself recently broke her left arm, sustained in Afghanistan. It is now healed, but says much about the person.
Slightly to my left is David, a surgeon, again from Darwin. He is deciding whether to re-attach the ear of another local man who had been hit by flying debris and had escaped with his life. The ear remains attached by a tiny skin flap but is still viable. The wound is dirty, so David decides not to re-attach the ear, but to clean and dress it instead. Re-attachment can be later, once the wound is clean.
This is real front line surgery with one day running imperceptibly into another. There are two operating tables in one operating tent. As surgeons we wear white hats that make us look like chefs. This period in Tacloban is an immensely valuable experience. Although we are here to bring assistance and support to the tragic victims of the disaster, it is also an opportunity to hone our own techniques, as operating in this environment is so different to work at home. Anything can walk through the door. It is not an option to turn anyone away.
We keep blood loss to a minimum at surgery as we do not have access to blood transfusion. There are few of the luxuries here that we have at home. Extreme caution is the order of the day. Safety is key, as theatre nurses keep a professional eye on every move in theatre. Any sign of standards slipping, or any sign of unnecessary risk, and they say so.