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An ER Doc in Haiti – The Series

Tuesday, February 2nd, 2010

I wasn’t aware, but EP Monthly has been publishing Dr. Plaster’s reports from Haiti in real-time.

Here’s a link to all his posts. Definitely some things that you don’t read about in the newspapers.

He’s coming home now as larger organizations step up their efforts to assist those in need of care.

An ER Doc in Haiti: Day 3

Monday, February 1st, 2010

EscombrosBelAir5

January 27: We’re seeing a stabilization, but what about follow-up?

We are right down town in Port-au-Prince today; pretty much every building around us is destroyed. The only thing still standing near us is a church, which is currently housing a local boy scout troop.

The effort is starting to see a logical transition right now. At the clinics you’ll get 10 to 20 people walking in with soft tissue injuries – big gaping wounds that are infected – but fewer and fewer people are needing amputations and surgery. I did get a call from a guy in an outlying area who needed a hand surgeon, which we arranged. Other than that, we’re seeing a stabilization. We’re running a clinic today and it’s a typical third-world situation. You announce that you’re available and everybody who has had a backache or a stomach ache for the last five years shows up. As soon as we arrived today, about 200 people queued up. They were very calm and controlled, lots of kids with dehydration and plenty of vague complaints. We’ve got eight treatment stations, 2 or 3 wound treatment stations, a diarrhea station, an upper respiratory station and then whatever else walks up. It’s typical emergency medicine, really. You have to sort through the masses to find the people who are really sick. Haitians can be hypochondriacs just like Americans. They never get to see doctors, so when one shows up who is free, everybody lines up. Generally speaking we’ll run into about a dozen seriously-injured people in a day, but we’ve got to sort through 400 people to find them. We’re going to another place this afternoon where there are supposed to be some very, very sick people.

ComfortUSNS Comfort on diversion?
I got my first look at the USNS Comfort, which is off shore a couple miles. We’re next to a landing zone where helicopters are flying in and out, but right now there is no one waiting to go out. The word going around is that the Comfort is basically full and they are now trying to figure out how to bring people back on shore. The army was talking about setting up a 250-bed post-op rehab facility for all of the people coming off of the comfort. They have some tremendous injuries out there, spinal cord injuries and ICU patients, that will really require follow-up care.  It’s going to create a problem on the backside. We’ve heard that the Obama administration has set a timetable for pulling forces out of Haiti – which makes sense – but there is going to be a lot of long-term care that they’ll need to plan for. There are a lot of sick and injured folks here.

Heavy on medical supplies, light on water
We’ve got medical supplies coming out our ears, but they told us when we left the camp this morning that we had no more water. They said they were going to go try to find water for us. I’ve got a bottle on my back and one in my pack, but that’s the end of my personal stores. I’m assuming we’ll find more – we’ve got a logistics expert tracking it down – but we’re getting a little hungry. I had nothing for breakfast and I have yet to eat my Powerbar for lunch. I’m hoping that I’ll get something for dinner.

Surgery Transfers
I’ve been taking patients who need surgery to Sacre Coeur (Sacred Heart), where they can receive treatment, since I know the doctors there. I put them in the back of a truck and take them there personally. When you walk into the hospital, you immediately hit an interior courtyard which is set up as a triage emergency area. It’s a big giant mess. A doctor sits out in the middle of the courtyard with hundreds of people around him, sorting through to find the ones that need to go in for surgery. I was able to bypass this, discuss the patient with the doctor, and take them straight inside. Yesterday I ordered my own X-rays, read them and handed them to the surgeon. It made for a very efficient system.

An ER Doc in Haiti: Day 2

Sunday, January 31st, 2010
Mark Plaster (R) and Father Jim Boynton ride through Port-au-Prince in the back of a pick-up

Mark Plaster (R) and Father Jim Boynton ride through Port-au-Prince in the back of a pick-up

January 26: Where there are no doctors

Yesterday we just drove down the road and found an open area where we could set up a triage station. We pulled out a tarp, some line to hold everybody back, and just let people come through. We laid out our meds on a table and then just worked through the crowd. Most of the injuries were pretty minor but a couple of them were major, broken bones and such. We probably saw 3 or 4 major cases that morning.

Our team is going to places that haven’t had doctors yet. A man told us that a week ago he’d told the UN that they needed help out here but no one had come out yet. To be honest, I had no clue where we were. We drove about a half hour into the heart of Port-au-Prince, a very poor area, people living in tin huts and surviving off of Coleman camp stoves. But I also saw some big, wealthy houses around here. Some of them have fallen down. If it was poorly built it fell down and smashed people. The construction is terrible; they don’t have any construction rebar, they build with cinderblocks and they only have these tiny wires going through them. Even homes that look well made may only have a thin skin of concrete on the outside. One more aftershock and they may come down.

I haven’t made contact with the navy yet. We wanted to get a feel for what we needed and how difficult it was going to be. So far it looks relatively simple. Right now we’re just trying to find the people who are most sick. There are a lot of people coming in complaining of back aches that they’ve had forever, but since there is a doctor here they all show up.

We had a surgery team show up Sunday and they heard [that there was a need for surgeons]. They went to four different hospitals and all four said that they had all the surgeons they needed and refused to give them any space. Operating space is very limited. These guys are working very hard, 8am to 10 at night.

I’m concerned about follow-up. I asked one doc what he was working on and he told me that he was putting on external fixatures. When I asked him who would be taking these fixatures off, he said, “I don’t have any clue.” When I asked him what had happened to the patient he had just put a fixature on, he replied that she “went back out and lay on the ground.” Somebody, someplace is going to have to take that fixature off and they won’t have clear information on when it was put in. We’re talking 4-6 weeks down stream somebody has to take over these cases and they’re not even in the hospital. A lot of them have been lost to follow up. Like the little girl I saw today: the bandage I put on her will probably be the last bandage she gets.

…more tomorrow

On the Ground in Haiti: Notes from an Emergency Physician

Saturday, January 30th, 2010

The earthquake in Haiti has created a tremendous need for donations and support for the Haitian people. Emergency Physicians Monthly took the mission to heart. Editor Mark Plaster, MD went to Haiti and has been assisting in the relief effort since January 24.

In addition to my posts, I’m going to add Mark’s notes and pictures to this blog. They are a captivating insight into what is happening on the ground in Haiti.

The first edition is below.

———————————————————–

January 25: Getting to Work

When we got off the plane, Port-au-Prince was almost completely black. There is almost no light here. We unloaded the aircraft ourselves and it was just a giant scramble getting all the bags off. We had bags in seats and the inside of the aircraft was total chaos. It was shocking that we got all our gear off. We were met by a team Rubicon leader named Jake Wood, a 6′ 5″ ex-marine sniper who was now a medic. On his own, Jake had decided to come down to Haiti and help out. He’d grabbed a couple friends – some people he didn’t even know – grabbed some sleeping bags and flew to Santo Domingo, DR. They rented a car and just drove in to Port-au-Prince. They made a connection with a Jesuit Mission and just camped out in the mission yard and started seeing patients as fast as they could. They were cutting off limbs in the field . . . it was pretty chaotic when they first arrived. That’s when Jake Wood notified his father back in Michigan that they could use a second wave of team Rubicon. The team coalesced from all over the country – California, Texas, New York – and none of us know the other guys at all. We all just showed up and it’s been amazingly well organized. The team leader down here, Gary Cagle, is a medical logistics guy who worked with the U.N. He was able to put together a 501-c-3 in a matter of about four days and he raised about a quarter of a million dollars in order to bring a team down here and get the job done. So they showed up at the airport, we off-loaded all our gear and came over to the Jesuit Mission, everywhere was pitch black. They told us to throw our sleeping bags down on the ground and they’d introduce us in the morning when we could see everybody. All night long I could hear planes coming and going because the runway was so close. I could also hear babies crying, but it wasn’t until the next day that I learned that this was because the Jesuit mission is a refuge for the homeless.

Team Rubicon Bravo lines up for a photo before heading to Haiti.

Team Rubicon Bravo lines up for a photo before heading to Haiti.

*******

The Jesuit Mission itself is a gorgeous old Spanish-style building, but it is unusable. It’s about to fall down and nobody can actually go in it. It’s a tragedy. Everyone is now living and cooking out in the yard. There are about 40 of us here now but there is a whole group that is leaving today, surgeons who have been here for a while and have to go home. People are coming and going all the time. But it’s moving into a different stage at this point. We are now seeing wounds that were handled by people 5-10 days ago. I just took care of a little girl, probably three years old, who had her leg amputated traumatically and we were just cleaning up and redressing her wound. Whoever handled it initially didn’t try to do a true amputation they just kind of cleaned up the wound and took the rest of the leg off. We’ve seen fractures – I just treated a guy with a lower leg, tib fib fracture that was never set, never seen by anybody. Somebody just got him some crutches and he’s been limping around with an untreated fracture ever since. We’re using cardboard and duck tape to stabilize his fracture because it’s too late; we can’t get it to set at this point. The surgeons at the local hospital operated until 10pm last night and they had another 200 cases waiting for them. There’s a lot of open fractures down here, a lot of orthopedic work.

Team Rubicon leaders Jake Wood (L) and Larry Cagle
(pictured: Team Rubicon leaders Jake Wood (L) and Larry Cagle)

One serious problem down here is the lack of follow-up. Some docs are putting in external fixators, but they are leaving them with nobody scheduled to follow it up. A lot of people are walking around with X-rays and medical records and hoping that at some point somebody will take the bars off their legs.

Today we drove away from Port-au-Prince and found a place to park under some trees. We’ve got two trucks out here and just set up a bunch of chairs to see people. The people have been very obedient and calm, we just have to make sure we’re not passing out food and water. We don’t see starvation but people are certainly not happy. But at the same time in Port-au-Prince people are coming back out. They can be seen sitting outside eating and drinking.

…to be continued


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