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Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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From Haiti - Thursday, January 21

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Today was another remarkable day. Here are some of the highlights:

The team continues to be incredibly strong and we are receiving reinforcements from all directions, both from International Medical Corps and from many other NGOs. Before I go any further, I want to express my appreciation for the incredible effort from the U.S. Army, which has provided protection, supplies, transportation, medical assistance and most important, peace of mind. This is not an easy situation, and having a compassionate and responsive military, never shirking a task when we need their help, is incredible.

We continued to triage, operate on and otherwise treat approximately 700 patients, with injuries that will change their lives forever. We have seen countless amputations, disfigurements and open fractures, and face wounds that are in some circumstances infected to the point of gangrene. The medicine is intense, but we are up to the task most of the time. It is quite hot outside and there is little time to eat, drink or go to the bathroom, so by the end of the day we are quite tired and bit dehydrated. But we do not complain, because these people are so strong and now so disadvantaged.

The USS Comfort took more than 50 patients from us today, many of them quite ill. They were transported by vehicle to a landing zone and then helicoptered to the vessel. We await word on the capacity of other hospitals in Haiti.

WOW. We just suffered a serious aftershock. Right now. The building just shook and everyone ran outside. I am sitting here and continuing to write. Is this emotional progress? My heart is racing. I am determined to get this information to you.

Tomorrow I will be spending most of my day working to help structure interactions within the entire medical compound, to identify all the resources and to be certain that everyone can find out how to get help. I am now splitting my time between clinical care and administration.

I will share a typical story of a patient. She is a small 3 year old girl who had the side of her face crushed under rubble. Her ear and cheek were mangled and abraded. When I found her in the crowd a few days ago, I was able to treat her wound, then transfer her to a team of Swiss surgeons who debrided the wound and administered antibiotics. Today the infection has progressed and it is also apparent that she may have a broken femur and be developing a compartment syndrome in her leg. Her face is swelling, but she is a brave little girl. We will do all we can for her. She lies in a tent on with a young boy with a spinal cord injury, children with missing limbs, burn victims, and so forth. This is not easy to watch and not easy to write, but it is real. We are helping each and every patient and have gotten to the point where we have enough staff to examine everyone at least once a day.

The surgeries will continue, and we now have a dialysis setup for kidney failure patients and those with crush injuries, a central storehouse, and a small blood bank, the latter from the Haiti Red Cross. The Norwegian Red Cross is putting up tents as fast as they can get them. We are hoping to transition to a 24 hour operation soon with adequate staff.

Much is improvised - traction, some splints, beds, etc. We are seeing the supply chain begin to get caught up. We have had patients that are not earthquake related, like gunshot victims, but we have not yet seen the "second wave." We know it is coming.

Out on the streets, it is difficult to conceive how this country will recover with a massive international effort and support. I hope that the world pays attention, because it could happen anywhere.

Tomorrow comes soon. I will try to write at the end of the day.
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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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