Are nurses doing anything important in Aceh province?

January 6, 2005 -- Today the New York Times ran Jane Perlez' "For Many Tsunami Survivors, Battered Bodies, Few Choices," which reports that many survivors of the recent tsunami are facing unnecessary amputation or even death because of a lack of emergency care in Aceh, Indonesia. Given the lengthy piece's almost universal descriptions of care as being provided solely by physicians, and its reliance solely on expert comment by physicians, no one could possibly come away from it thinking nurses or other health care workers are doing anything of significance in the stricken province. The piece appears on the Times' front page, above the fold.

Let's be fair. Not a single nurse is named or quoted in the piece, nor are the actions of any nurse described, but the word nurse does appear once, when the piece notes that Dr. Paul Shumack is "head of an emergency surgical team of Australian doctors and nurses." And there is one other vague reference to non-physicians, as "four hospital volunteers" carry a dead woman to a waiting vehicle on her way to burial. Dr. Shumack, who is quoted extensively, is described as holding the head of this dying woman for ten minutes as she draws her last breaths. We don't doubt this occurred, and all credit to Dr. Shumack, but we can't help but wonder about the impression readers will get about who is more likely to be performing such an important act--nurses or senior surgeons.

Elsewhere, in addition to quotes from Dr. Shumack, we get multiple quotes from Dr. Rene Zwellinger, Dr. Paul Luckin, and Dr. David Scott--all men. We also learn that "doctors here say" that many of the seriously injured died before "medical teams" could arrive; that "doctors say time is running out;" that "doctors knew" the amputations "spelled a hopeless future in [a] land lacking crutches, let alone prosthetics;" that "doctors" asked a translator to explain a patient's options; that "doctors" were doubtful about his chances; that "[m]uch of the doctors' work on Wednesday was to save remnants of families;" that "doctors" carried a patient into the OR; that a skin graft would be done by "an American team of doctors;" that working conditions for the "team of volunteer doctors" were far from ideal. We also read a number of comments from physicians about infections and wound care.

Forget about the extent to which many of these activities are generally the province of nurses, especially handling infection, wound care, the practical aspects of rehabilitation in a poor community, and patient relations generally; we are a little surprised that the author neglected to mention how physicians are rebuilding all the structures of Banda Aceh by hand and serving bowls of soup to every living resident.

The photos and captions accompanying the story reflect this bias completely, focusing on physicians, and using language that clearly suggests that only "doctors" are providing care to the victims, even though it appears that the camera has incidentally caught nurses and other caregivers at the bedside. The story also ignores all local caregivers, suggesting that only Westerners are providing important health care in Banda Aceh.

We salute the nurses, physicians, other health care workers, aid workers, government employees and private citizens who are working to alleviate the tremendous suffering in Indonesia and the other nations affected by the tsunami. We especially salute those whose work remains largely invisible to the wider world, because it appears to escape the notice of some whose job it is to observe carefully and report in a balanced and accurate way.

See our follow-up article regarding reader response: "Physician and Center debate merits of New York Times Banda Aceh story."

See Jane Perlez' article "For Many Tsunami Survivors, Battered Bodies, Few Choices" in the January 6, 2005 edition of the New York Times.

Please send your comments to Jane Perlez at foreign@nytimes.com with "Jane Perlez" in the subject line.

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