Reflection from Haiti, January 20, 2010
Medical Situation in Haiti Improves, But Much is Still Needed
I returned yesterday morning from Haiti, and Drs. Richard Lee and Julie Spielman were kind enough to meet me at MIA to give me a ride home. Dr. Banta was definitely a hard act to follow, as I heard him praised over and over by the doctors and nurses who had worked with him. There have been a lot of changes since then, as medical workers were pouring into the make-shift hospital. Similar to James’ experience, we were involved in a lot of non-ophthalmic care, including assisting in some of the many amputations being performed.
Tom Shane and I rounded on all of the approximately 200 patients to survey for eye injuries. Many patients had severe facial swelling from blunt trauma as well as cellulitis. Fortunately, most patients had only minor ocular injuries such as subconjunctival hemorrhages, infected lid abrasions, and facial cellulitis. We did evaluate a woman with a naso-ethmoidal and left orbital fracture with decreased ocular motility, a traumatic optic neuropathy, a post-operative posterior ischemic optic neuropathy, and conjunctivitis. Tom Shane and I helped transfer five critically ill patients to the Israeli field hospital, and found it to be quite impressive with an imaging center, lab, NICU, and ICU with ventilators. The hospital was located off the airport, and we saw first hand some of the devastation as well as a huge tent city housing the displaced Haitians.
The conditions at our field hospital were quite primitive and basic. The first night we were there, I helped with an amputation by holding a flashlight over the surgical area while the trauma surgeon amputated an arm with the patient under ketamine anesthesia on the concrete behind one of the two hospital tents. Conditions improved on our second day there as we arranged an OR area in one of the tents using two folding tables as operating tables and divider walls.
Our minor OR nurse Ashlee Vainisi scrubbed on approximately 10 amputations the first day, and surgery proceeded well into the evening. She did an absolutely outstanding job. On our second day, Tom Shane, Ashlee, and I set up an eye clinic and wound care clinic between the two hospital tents. We provided shade by spreading large tarps over the area, cleaned up the trash and moved boxes, and made a quite nice little clinic. Part of this area was reserved for the wound care doctors who performed dressing changes. We did visual screening, used the auto refractor, and provided glasses (mostly readers), artificial tears, vitamins, and anti-allergy drops when needed to over 140 patients. We also attended to dressing changes on our inpatients, performed dilated exams, and received a few emergencies including a reporter with a conjunctival foreign body and pain, as well as a young girl transferred from another clinic with a large infected cheek laceration extending into the maxillary sinus combined with swollen eyelids on the involved side.
Tom Shane was excellent with his boxes of glasses and organizational skills. He is now working as the UM envoy to the organizational meetings being held throughout the day at the UN between all of the NGOs (approximately 30) involved in the efforts. The whole hospital is soon to be moved to a different area, with large air-conditioned tents paid for by Miami Heat’s Alonso Mourning. Presently conditions are quite cramped, and most of the staff sleeps when they can on the floor of a stage at the end of one of the tents. Tom, Manny, Ashlee and I found a place to lie down between the tents on tables the first night. The second night we camped outside near the tents for a while. Drinking water arrived at the hospital on a regular basis, and patients and medical staff had adequate water to drink. Food consists mainly of power bars, peanut butter, crackers, and occasionally bagels and bread, and is spread out on a table where staff members sleep and keep their personal belongings.
The patients were stoic and calm, but one could hear the constant cries of pain as analgesics wore off and dressings were changed. Even with the hell they were going through, patients rarely complained and were happy each time we examined and cared for them. On our rounds Tom and I encountered an 18-month old baby girl with cerebral palsy and scalp lacerations who was alone. We were walking by and heard her crying. We picked her up, fed her and held her, and she seemed very happy. Thereafter we made it a point to round on her and feed her several times each day. Patient family members provided basic care to the injured patients including feeding them, cleaning them, and emptying their bedpans. Two infectious disease doctors from UM help coordinate the intravenous antibiotic therapy that most patients need due to infected wounds, amputations, and crush injuries.
Reporters were constantly touring the facility, and the President of Haiti stopped by Monday evening. Emmanuel Paz (“Manny”) from anesthesia has been an extremely hard working member of the team, providing ketamine and propofol anesthesia for amputations with basically no monitoring equipment except for a pulseoximeter. On our first morning, a woman was rushed in who had been trapped under the rubble of the Caribbean Supermarket for four days in a couched position. She was obviously very dehydrated, but fortunately had no major injuries. Manny managed to start a 14 gauge IV, and she was quickly hydrated. You could see life coming returning to her, and her relief to be alive and under medical care. Later in the day we loaded her into a truck to be air-transferred to JMH. I’m going to try and locate her today at Jackson.
Many major problems persist. Patients with pelvic fractures have no place for treatment, as neither our hospital nor the Israeli hospital is equipped to deal with them. They may die of injuries that would be easily treated in the US. The same goes for spinal injuries. Fortunately, fewer patients are dying now because they are receiving their needed surgeries quickly. Immediate hospital needs include monitoring equipment, intravenous antibiotics, narcotics, ventilators, a laboratory, and imaging equipment. Ophthalmic needs include more antibiotic ointments and glasses.
My patient in Haiti asked me to call family members when I returned to Miami. It was a very moving experience to call them and let them know he is alive and being well cared for in our hospital camp, as they had not heard any news of him since the quake. It looks like the UM involvement in this effort will be a long term commitment, and I’m glad to see Bascom Palmer is able to play a vital role in the delivery of health care to this devastated country. I want to go back, and I hope our residents, fellows, and faculty members will also give of some of their time and skills.
Thomas Johnson, M.D.
Bascom Palmer Oculofacial Plastic Surgery and Reconstructive Surgery Specialist