We have seen multiple reports of gangrene and sepsis over the past several days. Unfortunately yet another expected infectious disease issue.
The below narrative by a New York City orthopedic surgeon provides, in graphic detail, the infectious disease challenges that have been observed in the Haiti response theater. Here we have decided to protect the identity of the team involved. They were gracious to provide a blunt testimony of their experiences.
I believe we went in with a reasonably comprehensive service we wanted to provide acute trauma care in an orthopedic disaster. Our plan was to be at a hospital where we could utilize our abilities as trauma surgeons treat the acute injuries involved in an orthopaedic disaster. We expected many amputations however came with a philosophy that would reasonably start limb salvage in what we thought was a salvageable limb.
[The team] included:
- 2 orthopaedic trauma surgeons
- 3 orthopaedic trauma fellows
- 2 highly skilled anesthiologists
- 1 general surgery trauma surgeon
- 2 scrub techs
- 1 trauma nurse practitioner to do triage
- 2 OR nurses
Our equipment including a huge amount of anesthetic medications and equipment, ability to construct 150 external fixations both small and large, OR equipment including scalpels etc, OR soft goods, splint material, OR prep material.
We also had a plan of physician and equipment replacemnt that was dynamic where within 24hrs we could bring in what was necessary on private jet.
We thought the plan was a good one.
We were incredibly naïve.
Disaster management on the ground was nonexistent. The difficulties in getting in despite the intelligence we had from people on the ground and high political connections with [XXXX] as well as [YYYYY] only portended the difficulties we would have once we arrived.
We started out Friday morning, got a slot to get in Friday that was eventually cancelled when we were on the runway to be rescheduled the next day. We diverted to the DR and planned on arriving in PAP Saturday.
Once on the ground the hospital we had intelligence that was up and running with 2 OR's General Hospital was included severely in the earthquake and not capable of running functioning OR's as there was no running water and only a limited electrical supply on generator.
We quickly took our second option: Community Hospital of Haiti. We found approx 750 patients in the hospital upon our initial evaluation, the hospital had running water, electricity and 2 functional OR's. [In] our naivette [we] did not expect that the 2 anesthesia machines would not work, there would be 1 cautery for the hospital, autoclave that fit instruments the size of a cigar box, no sterile saline, no functioning fluoro and no local staff only a ragtag group of voluntary health providers who like us had made it there on there own.
To summarize we had no clue the medical infrastructure of the country was so poor.
As we got up and running in the OR and organized the patients for surgery we communicated our new needs back to [ZZZZ} and more supplies were loaded for a second trip - these included battery operated pulse lavage, a huge supply of saline, soft goods in the OR. This plane landed as planned Sunday pm, equipment was loaded on a truck and subsequently hijacked between the airport and the hospital.
At the hospital we had zero security despite promises form to provide that to us.
Our philosophy was to work like this was a marathon run the OR's around the clock with the idea that we would have a defined extraction time of 11pm Tues. The plane that extracted us would come in with a new medical staff compliment to replace us. Equipment included urgent things to maximize issues that were nonexistent in the hospital that would enable us to provide better and more efficient care:
- 2 portable anesth machines
- 2 electrocautery
- 2 portable monitors for the pacu
- 2 autoclaves
- Replacement exfix
- Things that didn't arrive with the previous flight
That plane's slot was cancelled by the military at 6am Tues.
We also previously had seen daylight in the remaining patients Monday night having completed approximately 100 surgeries. However on Tues morning we found a huge number of new patients. The hospital was forced to undergo lock-down closing its gates to the outside and outside crowd becoming angry.
We also noted Tues morning that many of the patients we were operating on were becoming septic.
We finished operating at noon Tues, the last surgery our group assisting an obstetrician on a Caesarian and resuscitating a baby that was not breathing.
We decided as a group the situation for us at the hospital was untenable supplies were running out, team was exhausted, safety a huge concern, and no extraction plan with resupply. We decided to make our way to airport through the help of a hospital benefactor. Jamaican soldiers with M-16s were necessary to escort us out with our luggage as the crowd outside saw us abandoning the hospital.
We made it to airport on back of a pickup track, got onto the tarmac, hailed a commercial plane that carried cargo to Montreal and had private jet pick us up there.
The issues we were unprepared for and witnessed were:
- The amount of human devastation
- The complete lack of a medical infrastructure in the country
- The lack of support of the Haitian medical community
- The complete lack of any organization on the ground
- Lack of any security at all at the hospital
No one was in charge, we had the first functional up and running
hospital in the PAP area yet no one and I mean NO ONE came to the
hospital to assess what we were doing, what we were capable of doing
and what we would need, to be more efficient.
I would take away that disasters like this need organization on a much higher level than we had with the clear involvement and approval of the military from the beginning.
Currently there is no one obviously running the show and care is in chaotic at best. MD's are coming in country with no plan of what the are going to do. Surgeons that expect to just show up and operate are delusional as to what there role would be as without a complement of support staff and supplies they would be of limited or no value...