Haiti Update: Doing the Best We Can
There is a beautiful luxury hotel called the Villa Creole in Port-au-Prince where the likes of Sanjay Gupta and Anderson Cooper and their respective entourages are staying. The owner took pity on us and provided a floor of her conference hall for some of our group to stay in; the other half is staying on the floor of an abandoned building in tents.
Today was more hopeful because more help arrived and more people were helped. But it also brought with it more complications. Our ER was supplemented by a few additional doctors. Tracy was exceptional. She started reducing fractures from the moment she hit the door. As an example, I couldn’t get a line into a patient’s vein but working together got ketamine directly into her femoral vein and quickly reduced her hip dislocation. The scary thing is that when our pain medications ran low, we had to continue to change wounds and reduce fractures to provide care. It wasn’t easy to induce more pain. More pain medications are on the way.
The vast majority of injuries are delayed treatment of huge lacerations and fractures. Lacerations can’t be closed after this time period because they trap infections and become worse. One must leave them open, keep them clean, cut away dead tissue, and bandage them up. One cute 8-year-old who still wore barrettes, smacked me when I began changing her bandages. She was seriously upset. It was funny at first, then became tough when I saw lime-sized chunks of tissue missing on both legs. Luckily, unlike many others, they were not infected, so I cleaned them with betadine, packed them, and bandaged them up. I can’t say she smiled afterwards, but she didn’t cry, and she looked at me quietly. For a moment things were okay.
When a femur or tibia fracture comes in, we check to see if it is open, whether it penetrated the skin, or whether it closed. The open ones go to the OR. They are usually infected, and usually lead to amputations. That means, in the past, a person with just broken leg would be back on track in a few months. But now, they’re in danger of losing their limb. No matter how bad, I try to put the bones into place as best as I can estimate, make a splint, give them Tylenol, and send them home. I know home doesn’t exist, and sending them away is hard, but here are so many people to see and very limited post-operative space.
Even now, new buildings open up. Bill Clinton stopped for a visit. Our emergency department director, Bob Norris, was too busy to look up. A crew of 30 Haitian doctors showed up as well as a few Swiss pediatricians. The army offered to helicopter out a few complicated patients. It seemed like positive things were happening. At the same time, even with more doctors, more bodies were arriving and no authority was visible. The early organization and standards of the International Medical Corp has been difficult to maintain. One Emergency Room physician I was working with told me he didn’t know how to do a splint—which made me wonder if he was a physician. Everyone I’ve worked with and talked to has been very good and even this person was very nice. Organizational questions are cropping up—where do we go, what area do we work, how do we communicate, how will we get along? Hopefully, these questions will be continually solved if we keep the big picture in mind, remove any egos, and keep maximizing care. It should work.
Follow the rest of Healthline's Haiti coverage here.
Find Dr. Menon's other dispatches here.
Health organizations in Haiti:
American Red Cross
International Medical Corps
World Health Organization
Doctors Without Borders (Médicins Sans Frontières)
Partners in Health
Haitian Health Foundation