Update from Haiti: Provide Help to the Fullest

January 27, 2010






As a member of the Armed Services, I am very proud of our humanitarian effort in Haiti. Not only did I arrive in Haiti with the permission of my commanders at the 173rd Fighter Wing, I also worked with the 82nd Airborne and the U.S. Navy to move 50 patients today so they could receive definitive medical treatment. Complicated surgeries could only be performed on the USS Comfort medical ship. We expect another 50 patients tomorrow. I joined to help people, and thanks to support like this, we have the capacity to help to the fullest.

Anil Menon


To read all of Dr. Menon's updates, click here.

To read Dr. Paul Auerbach's blog from Haiti, click here.

For more of Healthline's Haiti coverage, click here.

Labels: earthquake, emergency medicine, Haiti

Permalink | 0 Comments| Email Post

Post your comment

Haiti Update: The More They Remain the Same...

Labels: earthquake, emergency medicine, Haiti

Permalink | 2 Comments| Email Post

Post your comment

Haiti Update: What I've Learned

Editor's Note: Healthline blogger and Stanford University emergency medicine instructor Dr. Anil Menon is in Haiti to help with the global effort to provide medical care in the wake of the January 12 earthquake. Because communication outlets are limited, he has been sending updates to his mother via text message. She has been transcribing those messages for us so we can pass them along to you. Please know, these updates are being relayed directly from Dr. Menon, and the information, at times, is graphic and might be emotionally difficult for some people to read. We will be posting new updates as we receive them in the days ahead. 

January 25, 2010

Top five rules for helping in a disaster.

1) Smile and Care: “It means more than any treatment you might render,” Garrett Chan told me this, and I believe it to be true. The more I do, the more questions I get asked, the more directions I get pulled into, the more important it seems to be there. The people that smile the most, those are the ones I will remember.

The most positive memory will be my very first patient (see picture below). He was 16 years old and had a swollen leg with obvious cellulitis. I met him on my first day in Haiti. His first through third toes were completely necrotic and dangling off his foot like autumn leaves. I was overwhelmed that day, but I couldn't walk away. By our triage system, he was someone else's responsibility. Everyday, I stopped, smiled, changed his dressing, and eventually got him to see Dr. Pier. His toes were removed. Now I see him everyday in the post-operative area. Someone said he would probably win an olympic race, with his attitude. I wouldn't be surprised. 


2) Be flexible: Every day is a new day. On the first I was a mostly an intern, seeing a few patients, referring them to the surgeons, and sweating when I saw patients walk through the door. At different times, I performed the jobs of a tech, a nurse, a transporter, or a scribe. On the second day, I replaced Bob Norris to run an area, know all the patients, and triage the patients for the surgeons. On the third day, I spent much of my time taking Bob's job, the one he vacated. It was running the triage pre-operative area, doing more administrative work, and meeting with surgeons so they don’t step on each other’s toes. A few doctors came, wanted to help, but were mainly interested in specific tasks—ones they found fulfilling. A disaster veteran, Dr. Tascone, who made 25 trips to Africa as part of a reconstruction process, took the night watch.

3) This leads me to the third point. Keep the broader goal in mind: You came to help in any and every way, and with that, all other problems are solved.

4). Work until you drop: There was a plastic surgeon named Dr. Silver, who could barely walk by the end of the day. He was older but he maximized his effort, and I figured I could do the same

5) Take care of yourself: I think you can recover physically like Dr Silver, but it’s more difficult to be present emotionally day after day. That’s why I write, and that’s why I appreciate all the support I receive.

The end of each day delivers a blow and today was no different. Four days ago, a woman was shot. She was 32 years old and survived the earthquake. But during an aftershock, when everyone scrambled out of the house, a shot misfired, hit her in the back, in the right lung, and left her paraplegic. She went to another hospital. She probably had a pneumothorax, got a chest tube, and was sent here before being air lifted to to the USS Comfort medical ship. She looked okay, didn’t seem to be in distress, even had her chest tube pulled by someone. But she never made it on the ship.

We couldn’t predict that she would develop a pneumonia today as she did. To be certain, we checked her lung, heart, and abdomen with an ultrasound, gave her more antibiotics and fluid, and began the transfer to another facility. It was tough to find a small bottle so we moved the large oxygen bottle onto the truck, moved her onto the truck. And that’s when she began to really decompensate. She was frothing at the mouth, moaning, and breathing heavily. I jumped behind her to prop her up and elevate her chest. Bob sat beside her and lifted her chin, and we scrambled to get the old pick-up truck running. A we moved out of the compound, I thought she would slip out the back of the pickup but Bob told us, “Don't worry. I’ve got her head in my hands,” as he lifted her jaw for better ventilation. I just focused on bagging her as we drove through the crowded streets, and was glad to have a national expert in airways at my side. There was actually another patient sandwiched in the back of this open pickup truck, another septic young woman. Bob kept repeating and reassuring her, “Don't worry, I won't let you slip, I’ve got you.” He didn't let her slip, and we made it to the Disaster Medical Assistance Team tent. We both told the people there to get an airway together immediately, but they seemed a little too calm. There is a fine line between composure and delay. Luckily, the army escort helped us rush her to the treatment tent while we asked for an airway. A cardio-thoracic surgeon told us he would intubate. Bob was reluctant but we’re on someone else’s turf. But the other doctor forgot his stylet, couldn’t see anything, and put it in the esophagus. Bob snatched the tube and quickly put it in. Unfortunately, her heart had stopped. CPR wasn’t enough and she didn’t survive.

There were so many turns that could have changed events—from transfering her earlier, not disconnecting the oxygen, recognizing her earlier, vetting communication, and being more assertiveness with the various care teams. It was tough losing her. I couldnt find her family. They got lost in the chaos.

Anil Menon

To read all of Dr. Menon's updates, click here.

To read Dr. Paul Auerbach's blog from Haiti, click here.

For more of Healthline's Haiti coverage, click here.

Permalink | 0 Comments| Email Post

Post your comment

Haiti Update: Life Goes On

Editor's Note: Healthline blogger and Stanford University emergency medicine instructor Dr. Anil Menon is in Haiti to help with the global effort to provide medical care in the wake of the January 12 earthquake. Because communication outlets are limited, he has been sending updates to his mother via text message. She has been transcribing those messages for us so we can pass them along to you. Please know, these updates are being relayed directly from Dr. Menon, and the information, at times, is graphic and might be emotionally difficult for some people to read. We will be posting new updates as we receive them in the days ahead. 

January 24, 2010

Apparently, not everyone got hurt in the earthquake. I wouldn't have known it from what I saw. A young kid was playing with his ball amidst the rubble and I realized that life moves on, no matter the magnitude of the problem. I'm worried that we will move on and forget the external fixtures that protrude from so many legs, or a nation full of amputees and without infrastructure. Greg Feldman told me he wanted to wrap up his residency in time to contribute to the continued surgical effort later this year. That’s a sign of true valor and concern and commitment.

Anil Menon




To read all of Dr. Menon's updates, click here.

To read Dr. Paul Auerbach's blog from Haiti, click here.

For more of Healthline's Haiti coverage, click here.

Permalink | 0 Comments| Email Post

Post your comment

Haiti Update: Anatomy of a Day

Editor's Note: Healthline blogger and Stanford University emergency medicine instructor Dr. Anil Menon is in Haiti to help with the global effort to provide medical care in the wake of the January 12 earthquake. Because communication outlets are limited, he has been sending updates to his mother via text message. She has been transcribing those messages for us so we can pass them along to you. Please know, these updates are being relayed directly from Dr. Menon, and some of the information is graphic and might be emotionally difficult for some people to read. We will be posting new updates as we receive them in the days ahead. 

January 22, 2010

Each day brings a new challenge and a completely different job description—so much so that at times it becomes a blur. If I find a free moment, I scribble down what I'm doing, hoping this would help me make sense of everything around me, and would improve my thought process.

For the past few days, we wake up at 0600 and drink only coffee for breakfast. Chris Sloan, an astronaut candidate and an emergency medicine doctor from the University of California, San Diego, brought a portable hypoxia monitor. Out of curiosity, I tested my heart rate and found it had gone from a resting heart rate of 50 to a rate of 85. Everyone else’s was about the same, with all of us hovering in the 90s. That must be due to a lack of water intake. One of the tips I learned is don't eat protein if you're in a survival situation, when you have less than a pint of water per day. It requires water in order for the protein to be utilized. This was just a curious medical thought because none of us had any time to eat. Most people managed a powerbar, at most. But again, this isn't surprising for people who work in the emergency department.

Around 0700 everyone crams into the bus and makes the 3-minute trip to the hospital.We start at the supply room and pack a box of injectable antibiotics, like ceftriaxone and ceftaz, and then grab a few of the more exotics ones if they are visible. Our top concern is to learn who made it through the night, where they might be lying today, and what new challenges this day will bring.

Guyta was helping me translate. I looked for him before heading to the pre-operation area. He spoke English well and told me his help at the hospital was “the price he was paying for surviving”. None of his family members was hurt and he felt guilty about his luck. He confessed, “I always felt I had one miracle to happen in my life—and it happened.”

As we talked and collected our supplies, another aftershock hit and everyone bolted for the door. No ankles were broken but it was clear no one was willing to return inside. One patient later asked me if they would be in danger of the earthquake if they were transferred to the USS Comfort medical ship.

It was good to know today more help was on the way—more supplies, and better coordination with our experience. The pain medications no longer had to be rationed, the IV fluid for people more dehydrated than us would be available, some food rations for patients, and specialty surgical care that never existed were coming.

One of the first people I looked for was a beautiful 5-year-old girl with bi-lateral femur fractures and a hematocrit of 15. She would receive our first blood transfusion (a special effort from the Haitian Red Cross) and would be on the top of my list to get to the USS Comfort (a floating hospital). The army was able to save her life as well as transport her via air evacuation to the Comfort. There they could handle neurosurgery, ICUs, CT scans, and fix many of the complicated orthopedic fractures which had to remain broken in our beds due to lack of IM rods, fluoroscopy, and other hardware.

The next person I looked for was an older woman named Official, who lost her right arm and leg in the earthquake. She was just brought in. Her son struggled to get her to our medical area. Dr. Pier, the lead surgeon, took her to the operating room immediatly for wound cleaning, debridement, and amputation. From the Haitian's viewpoint, the appearance that anyone who came to the hospital, left with an amputated limb, stopped many from coming. Though Official looked good the day she came in, given those injuries, she did not look good that morning. She couldn't talk and she struggled to breath. Early on, her 13-year-old son asked if she was alive. I thought, of course she is alive. I looked over and she wasn't breathing and didn't have any reflexes. My lowest point came when I had to tell her son she was not alive. I held him as he cried and asked if he had anyone to help. He didn't because they were all crushed by their fallen ceiling. It was hard to leave him, even when an older woman came to take my place. It felt insufficient to give him food because that wasn't enough. Even worse, the boy left sometime in the afternoon before we could be certain he had any support. I will never forget his face.

I'm reminded of the boy pulled from the rubble recently that was featured on CNN and the Los Angeles Times. Gaby helped this child and he returned to visit her. He looked so dry initially when he was pulled from the rubble. It does feel good to see people turn around, especially those with so much left to see and live.

To read all of Dr. Menon's updates, click here.

To read Dr. Paul Auerbach's blog from Haiti, click here.

For more of Healthline's Haiti coverage, click here.

Permalink | 0 Comments| Email Post

Post your comment