POSTED: 1:30 a.m. HST, Nov 16, 2013
LAST UPDATED: 2:10 a.m. HST, Nov 16, 2013
TACLOBAN, the Philippines » Richard Pulga lay on a hard steel gurney for five days with only a saline drip after being seriously injured in the typhoon that devastated his country.
On Friday, Pulga, 27, died -- essentially of a broken leg.
Doctors said the father of two small children could have been saved. Instead, he became a victim of the incompetence and inaction that have plagued relief efforts here for the hundreds of thousands left injured, homeless, hungry and increasingly desperate since the typhoon hit.
By the time Dr. Rodel Flores, the senior surgeon with a team of visiting doctors, found Pulga on Thursday, he had received no antibiotics and his leg was badly infected. The doctor ordered an emergency amputation to try to save his life. But it was too late.
"In short," Flores said, "it was preventable."
Pulga was one of the first victims of Typhoon Haiyan to be brought to the top government hospital in the city. He was there because he had tried to protect his home, sending his wife and children to a safer place as some of the highest winds ever recorded slammed into his island. Those winds sent a coconut rocketing through the darkness into his leg, shattering it.
His death is one of the clearest signs yet of the human toll taken by a slow and troubled relief effort since Typhoon Haiyan swept ashore Nov. 8. Like much-needed water and food, medicine -- including antibiotics -- was held up for days as rescue teams struggled to operate amid the chaos of a city with too few military to provide security and too little government control.
Aid workers huddled for days in the airport, fearful of venturing out amid reports of sporadic gunfire and after at least one convoy was raided by desperate people. Some of those workers have since said the inadequate government response has made this disaster more difficult in some ways than such historic catastrophes as the Indian Ocean tsunami in 2004.
By Friday, a full week into the disaster, aid had finally begun to flow more smoothly, at least into Tacloban, in part because of help from better-equipped foreign militaries trained to deal with natural disasters. Field hospitals had begun to be set up, but as with the Indian Ocean disaster, aid workers worried that infections from lacerations would claim many more lives.
For Pulga's family, the loss is catastrophic. A farmer, Pulga was one of the few men in his extended family able to earn money. In his final days, as he spoke with a reporter from The , it was that thought consumed him.
On Friday, his widow, Marycris Pulga, wept next to his covered corpse in a hallway at St. Paul's Hospital here, a private hospital the surgeons transferred him to in the last-ditch effort to save him.
After initially being too traumatized by the storm to visit, she had arrived in time for his surgery.
"I want to bring him home," she said Friday, "but we have no home left."
Pulga arrived at the first hospital, Eastern Visayas Regional Medical Center, shortly after the winds whipped up a wall of water that flattened much of the city.
The hospital had been partly swamped with seawater, and it lost its electrical supply and most of its medical supplies. In his time there, Pulga received virtually no care.
When his wound began leaking blood during the interview Wednesday, two health workers in orange Philippines Department of Health vests removed the blood-caked, four-day-old bandage, showed the wound briefly to a government doctor, then secured the same bandage with gauze to stop the bleeding.
The hospital was running low on antiseptics, antibiotics and painkillers, and Pulga received none. It was unclear why the hospital's triage team did not make him a higher priority.
Luminada Florendo, Pulga's aunt, said Wednesday that a doctor had suggested she take him home because she had no money for the extensive treatment he would need to recover; the doctor left before he could be interviewed.
When the visiting medical team from Davao in the southern Philippines showed up a day later, they concluded that Pulga was the sickest person in the hospital and ordered that he be transferred to St. Paul's. Dr. Mauri Bravo III, one of the surgeons who performed Pulga's amputation, said the wound had a distinctive fruity smell of infection. Pulga's eyes were turning yellow and his abdomen was distended.
Virginia Ausa, a nurse at Eastern Visayas Regional, said no one there had been aware that Pulga had been interviewed by an international news organization and that he was not singled out for special treatment by the Davao team. Flores said the same.
As the doctors prepared Pulga for surgery Thursday, it became clear to them that he was suffering from septicemia and that his body's ability to produce red blood cells was dwindling.
The hospital has lost its entire blood supply in the storm, and without equipment to test for blood compatibility, the doctors decided to amputate without a transfusion. Initially it appeared the gamble worked.
Pulga even regained full consciousness, but on Friday his body began to shut down. By late morning, he was dead.
Flores said the bill for his care would likely be covered by the Philippines Department of Health as part of its response to the typhoon.
When told the story of Pulga's final days, Mayor Alfred Romualdez of Tacloban -- who has been widely accused by residents of mounting an insufficient relief response -- was quick to deflect criticism, saying Eastern Visayas Regional hospital has long been "a problem."
Dr. Albert de Leon, the hospital's chief administrator, said malnutrition and other unsuspected weaknesses in people like Pulga sometimes made them hard to save.
"There are some things beyond the limits of medical knowledge," he said. "There is a supreme being who decides the fate of every one of us."
When told of Romualdez's criticisms, de Leon launched into such an angry outburst that another doctor rushed over to calm him. De Leon said his hospital was an excellent teaching and research institution and that the mayor should do much more to organize typhoon relief.
"We are in his city and yet he is not doing that -- even the garbage disposal, he doesn't do anything," de Leon raged in a hospital corridor that was growing dark at sunset and still had no electricity.
At St. Paul's Hospital, a security guard told Pulga's wife that her husband's body would have to be buried in a mass grave if she could not remove it. She tried frantically to reach relatives now that sporadic cellphone service in some places has returned, but she was unable to find anyone with a vehicle.
Marycris Pulga sobbed for more than an hour and refused to make a decision.
Flores and Bravo gave a lengthy interview in the hospital parking lot about Pulga's last days. Then they went back upstairs to the steel bed where Pulga's body had been lying.
It was empty. No one seemed to know where the corpse or the bereaved had gone.