Tetanus, Pneumonia, and Malaria in a Tsunami Victim in Banda Aceh, Indonesia

On December 26, 2004, a tsunami from the Indian Ocean struck the coastal city of Banda Aceh, Sumatra, Indonesia. This case report describes a 24-year-old woman who presented to the Dr. Zainoel Abidin Hospital in Banda Aceh on January 8, 2005, with a tsunami-related illness. The patient was initially treated for tetanus and aspiration pneumonia with a guarded prognosis. Her recovery was complicated by malaria and recurrent pneumonia. Treatment was hampered by a shortage of medication and equipment, damage to the hospital, and a filthy environment. Morphine, diazepam, and ketamine infusions were used to good effect. This case highlights some of the logistical problems of treating multiple tetanus patients in an austere environment.