I arrived in Port-au-Prince four days after the earthquake and worked for two weeks in St. Marc, a coastal town about 45 minutes north of the city. The scene outside the hospital was dismal; the streets were full of people, occasional collapsed houses, and long lines of cars near the few gas pumps that actually had petrol. Walking into the hospital on our first night, our team of doctors and nurses volunteering for Partners in Health found around 250 earthquake victims laying in heaps on the floors of the wards, open femur fractures, compartment syndromes, dead limbs with gangrene, bandaged orphans, vertical shear pelvis fractures and rhabdomyolysis. We developed the “fly criteria” to help gauge whose wounds were most infected.
Over the first two days we created order from this chaos, despite daily issues with security and mobs, lack of water, food and supplies. We were missing doctors and nurses from the Haitian staff and we had no communication with the outside world (no phone service, no internet and no sat phone service). The OR was cleaned and stocked and a recovery area was created from a stock room. Stretchers were cleaned and built and patients were laid in mattresses, identified, examined and comforted. We started a triage system and my job as the emergency physician on the team became not just emergency medicine and triage to the OR, but helicopter evacuation arrangements, riot and bed control, non-operative orthopedics, conscious sedations, and interfacing with the various other groups who came to “help”.
There were unanticipated challenges on a daily basis. An aftershock broke the floor in our OR and sent frightened patients leaping from their windows. Other patients were run over by cars while sleeping in the streets. Then there were the people who came to “help,” many with very different ideas of what might actually be needed. There was the smoking Frenchman with the load of bad apples and a group of Floridian nurses who worked so well in the wound clinic. There was the Belgian internist who helped me run the emergency department followed by an aggressive group with plans for bedside amputation under ketamine and questionable values regarding informed consent.
The Haitian physicians and nurses took several days to adapt to the influx of people, supplies, patients and chaos. In fact, it wasn’t really until day nine that we started conversations about roles and responsibilities. The main barrier was explained by one of the orthopods at St Mark: they thought we were too aggressive with amputations and they would have let the limb “turn black” before doing them, even at the risk of losing the patient to overwhelming infection. There was much we all had to learn about each other before we could work well together.
When I finally left, Port-au-Prince was beginning the transition phase. Despite the body count – over 200,000 and growing daily – many homeless in encampments and shortages of food, water, fuel and cash, things were getting a bit better. At St Marc Hospital, talk turned to amputation site molding, skin grafts, prospects for prosthetics donations, physical therapy and emotional support. Nurses were being trained to turn patients or get them out of bed into chairs. Walkers and crutches were in use and chronic disease treatment was back up and running. This new phase is the aftermath, and it will be a long, hard road.
When I think about our experience in Haiti, I am most struck by the compassion of our volunteers, both Haitian and American, and the resilience of the Haitian people. Their poverty-stricken lives can endure tragedy after tragedy yet still rejoice that they are alive. Life goes on.