We arrived in Bali in the early hours of 12 October 2002 for a week’s break from our busy advanced training positions. Little did we know that shortly after our arrival we would be thrust into the centre of a mass casualty situation caused by a terror attack aimed primarily at fellow Australians.
I was a second-year advanced plastic surgery trainee working at Royal Perth Hospital (RPH) attached to the burns unit, and my wife, Priya Thalayasingam, was a third-year advanced trainee in anaesthesia working at Princess Margaret Hospital. Priya and I met in our first year of medical school at the University of Western Australia and spent many of our junior years working at Royal Perth Hospital (RPH). During our time spent training at RPH, we often experienced and were familiar with dynamic, challenging and often chaotic scenarios.
The Bali bombing occurred at 11 pm on 12 October 2002. We witnessed an explosion in the distance while in a taxi returning from dinner with friends and we were unaware of what had occurred. We were awoken by a call from my parents at 7.00 am the next morning who advised us that there had been a terror attack against Australians and pleaded with us to not leave our hotel fearing possible further attacks. Despite their concerns for our safety, we made the decision to ring Sanglah Hospital and volunteered our services. We also contacted the Australian consulate to inform them of our plan in case there was a further attack on first responders.
On arrival at the hospital, we were met by assistant consular officer David Chaplin. What we faced was a chaotic situation with countless patients requiring immediate fluid resuscitation and urgent escharotomies. Working closely with a few other Australian medical volunteers, we set about tracking and treating patients to the best of our abilities with the scarce resources available. There was a lack of a hospital disaster plan, poor coordination of medical response and a severe shortage of resources, including staff, fluids, blood products, analgesics and ICU beds, among many others. At this early stage we concluded that the only chance of survival for patients was to evacuate them to Australia as soon as possible. During the initial hours we commenced basic fluid resuscitation, performed countless escharotomies to salvage critically ischaemic limbs and created a high dependency unit (HDU) with close observation (albeit no monitoring or extra resources) for the patients with the most severe burns.
We set about working with the consular staff and two military attachés assessing and triaging patients for evacuation. Communication to Australia regarding the severity of the disaster and coordinating the logistics in a dynamic environment on foreign soil while simultaneously continuing to treat patients was extremely challenging. However, despite these challenges, within 24 hours of arriving at the hospital and working with Australian medical and civilian volunteers, we had evacuated all of the injured at Sanglah Hospital.
The twelfth of October 2022 marked the 20th anniversary of this disastrous and cowardly act that marked the lives of so many Australians. As I ruminate upon this moment, I have come to realise how it made Priya and myself appreciate how much we took for granted—and how it has played an integral role in shaping the manner in which we conduct our practice.
The opportunities to train under leading medical practitioners in our fields of specialty engendered the spirit of our actions in Bali. Their tutorship equipped us with the skills and confidence to take control, to lead and to make critical decisions with conviction—despite being in the early stages of our careers. The privilege to train under such exceptional leading specialists was invaluable, and something we will always be grateful for.
Advanced specialist training
To any trainees reading this, remember: ‘You’re not a trainee for long—if you train hard, the game is easy.’ This sentiment encapsulates the true purpose of specialist training and is something that I believe all aspiring specialist trainees should remember. Advanced training is not about ticking boxes and simply doing the minimum to get you through. Instead, it exists to mould you into an outstanding clinician who possesses the ability to collaboratively lead a team, and to consistently make safe decisions with conviction and clarity. The harder you train and the more cases you see and do, the easier your journey will be as a specialist plastic surgeon.
The human spirit
As Barack Obama once said:
We choose hope over fear. We see the future not as something out of our control, but as something we can shape for the better through concerted and collective effort.'1
Indeed, we witnessed the power of hope as it ignited the human spirit, shining through the devastation of such a cowardly act of terror. Australians from all walks of life selflessly volunteered their services to help those in need. They came in numbers—offering to help in any way they could, whether it was bringing food, water, staying by an injured stranger, changing dressings or providing medical and nursing care. They chose hope, and they chose to fight—without wanting anything in return.
The power of humble leadership
We were Australian-trained medical practitioners taking control of the management of patients in a foreign country. We did not have medical registration that permitted us to work in Indonesia. It would have been easy to offend the local medical staff and administrators if we had demonstrated any form of arrogance. We had to lead with humility making local medical staff, other Australian medical volunteers and civilians feel valued and appreciated. Importantly, we were all part of a team that shared a common goal: the safe and urgent evacuation of the critically injured back to Australia. Respectful communication, diplomacy and collaborative teamwork are important in the daily care of our patients, are paramount in a crisis and make impossible goals achievable.
I learnt the value and the importance of closure. As a young adult, I didn’t place any weight on the concept of closure. Both Priya and I returned to our busy training positions the day after arriving back in Perth from Bali. In the year following the bombing, we would internally recount the events of the day wondering what we could have done differently to change or improve the outcome of the injured patients’ lives. The concept of closure is defined as resolving an emotional or traumatic experience. It was only after returning to Bali for the first year anniversary and talking to many of the patients we helped and volunteers who helped us, that we were finally able to achieve the inner peace that accompanies closure.
The experience made us more resilient and reinforced the importance of remaining calm when under pressure. As surgeons and anaesthetists, we are often placed in challenging and stressful situations. The team we work with looks to us to lead—leading with a calm demeanour brings out the best in your team. Not feeling sorry for yourself when you are in the moment also enables you to optimally deal with any crisis. Faced with the situation in Bali, we had to maintain a calm, resilient exterior as many were relying on us to provide this form of leadership. Additionally, we did not have time to think about the gravity of the situation until we had accomplished what was required of us.
Finally, we were grateful we had each other and were in Bali together. On the day we could bounce ideas off each other and work collaboratively as a surgeon and anaesthetist would in any crisis situation. In the aftermath, it was a lot easier for us to emotionally deal with our experience. We had experienced the same mass casualty situation and could deeply understand each other, which made debriefing and reflecting a lot easier.
The events of the 2002 Bali bombings will always be with us. A place in our hearts and minds will always be with the victims of the bombings, and with their families. While we will never forget the tragedy of the day, we will also remember the camaraderie, the power of hope and the effectiveness of a concerted human spirit that allowed us to unite against a brutal act of terror. The actions of those who helped us continue to inspire Priya and myself to this day, clearly encapsulating the words of Nelson Mandela:
Courage is not the absence of fear, but the triumph over it. The brave man is not he who does not feel afraid, but he who conquers that fear.2