1 International Society of Nephrology Turkish Society of Nephrology, Renal Disaster Relief Task Force 2 President, Turkish Society of Nephrology
Sir,
On 17 August 1999, a severe (on the Richter Scale 7.4) earthquake occurred at the Marmara region (in North-Western) Turkey. This industrialized region includes not only more than 70% of all Turkish industry, but also some of the major cities of Turkey (such as Kocaeli, Adapazari, Istanbul, Yalova, Eskisehir and Gölcük) (Figure 1).
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In order to analyse the severity of the problem, on the second day of the earthquake, a questionnaire was prepared and sent to all reference hospitals and nephrology units not only located in the disaster area, but also the ones that have been effective in all of the adjacent cities such as Ankara, Bursa and Eskisehir. The response rate to this questionnaire has been very high and more than 90% of the centres filled and returned the sheets. According to the preliminary results, more than 700 earthquake victims suffered from severe renal complications, which necessitated dialysis support in 491 patients. A detailed analysis of the disaster will be available soon, and will hopefully be useful and directive in the management of the victims of potential future disasters.
It was clear from the beginning that such an enormous medical problem would cause lots of difficulties not only in supplying disposable dialysis material, but also in finding health care teams, especially dialysis nurses, who are indispensable for the application of dialysis therapy.
The activities for determining the need for help.
On the second day after the disaster, while we had only limited information regarding the severity of the problem, we were visited by Dr Raymond Vanholder at our dialysis unit in the Istanbul School of Medicine. R. Vanholder came from Gent Belgium, as the representative of the International Society of Nephrology (ISN) Renal Disaster Relief Task Force, and Medecins Sans Frontières (MSF), offering help for relieving the problems related to this tragedy. He was accompanied by Dr Fikri Kutlay, who acted as a translator and coordinator for overall rescue activities.
His first question was: What is your estimate regarding the number of disposable dialysis material that can be necessary for the treatment of these victims? Actually, at that time (since no information regarding the severity of the problem was available) our reply was that very probably 1000 catheters, membranes and lines of each would be sufficient. R. Vanholder said: You should better multiply this number by 10, and it seems that you will need dialysis material and persons roughly for 10 000 dialyses.
Although it was hard to believe this figure at that time, later it became clear that he was correct, since, according to very preliminary results of the analysis, we have performed more than 4700 dialysis sessions for the treatment of acute renal failure cases due to the crush syndrome. Taking into account that we do not have dialysis figures of some centres so far, there is still continuing dialysis need for some of the acute patients and also chronic dialysis patients in the units of the damaged area, his estimation was probably close to the reality.
On 25 August 1999, Dr Norbert Lameire (Chairman, ISN-ARF Commission Renal Disaster Relief Task Force/European Branch) and Dr Ekrem Erek (President of Turkish Society of Nephrology) appointed Dr M. S. Sever as the disaster relief task force local coordinator. N. Lameire kindly asked Dr Sever to inform the committee of all of the nephrological needs (including not only the disposable dialysis material, but also the machines and nurses). He also underlined the importance of collecting the correct information regarding the results of the therapy.
The help.
Substantial part of the external (non-Turkish) nephrological help was made possible thanks to the generous support of a large number of aid providers, coordinated by the ISN/ARF task force, and to the logistic support of MSF. Working in close contact with Turkish Society of Nephrology and according to the needs, they planned and organized most of the international help.
The dialysis material donated by (or by means of) these two societies are summarized in Table 1.
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More importantly, this organization has made possible the contributions of five dedicated nephrologists who assisted the efforts of Turkish health care teams. Belgian, German and French experienced colleagues came to Turkey, in order to help the organization of health care and coordination of the activities. These doctors made regular visits to the disaster field in order to determine the needs and helped coordination activities. The names of these dedicated doctors are listed in Table 2.
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The modest MSF people did not want to give their names, nor their nationalities. Our sincere thanks go to all of these dedicated human beings, who are shown in Table 3.
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Conclusions.
The Marmara earthquake was a tragedy, causing too many deaths and renal problems. A detailed medical analysis of the disaster will detail useful preventive and therapeutic measures, which will be indicative for relief of the complications of potential future disasters. According to the preliminary results the mortality rate due to renal problems has been low. This low mortality rate was achieved by collaborative and dedicated efforts of both national and international health care teams.
It is certain that the disaster caused very deep sorrow, grief and sadness that affected not only the Turkish people, but also all human beings. However, the disaster also proved that collaboration, friendship and dedication might save many lives and is helpful in relieving the sorrow.
The generous and kind helps of our dedicated colleagues and friends will always be remembered by the Turkish nephrologists.