Friday, January 22, 2010

Medical Relief for Haiti


Photo credit to Operation Rainbow, Photographer Mike Lee


No One knows what the death count in Haiti is. Whenever they start estimating "fifty to a hundred thousand", you know it is just a guess. But the number is huge. Entire schools, office buildings and hotels collapsed, crushing the people inside. Tens of thousands of people were injured and they are flooding the makeshift medical tents and hospitals in surrounding areas.

I staffed a medical site at Katrina. The problems there were fairly routine because the people had simple injuries and were mainly displaced and in shock. Hospitals were functioning in Baton Rouge and we had access to medication and supplies. That is not the case in Haiti.

The initial wave of victims had crush injuries and compound fractures where the bones were split and sticking out through the skin. Without X-ray equipment or orthopedic pins and bolts the only treatment is a makeshift splint or amputation. Dressings were hastily applied and the medics went on to the next one. There were thousands of patients waiting to be seen. Those early patients now have gangrene in the wounds. Some of the more serious have a condition called rhabdomyolysis where muscle chemicals are released and cause renal failure. Without IV fluids and dialysis, the patient often dies.

I heard from a doctor volunteer this morning that there are now enough medical teams, but the lack of operating rooms and equipment is still critical. University Hospital in Port au Prince has temporary operating rooms going 24 hours a day but they still lack modern anesthesia, imaging and surgical tools. The last time this many amputations were done was during the Civil War. When a leg is crushed and infected, that is all that can be done to save the patient...maybe.

The USN Comfort floating ship hospital has arrived and has capacity for 1000 people. The most serious cases are being shuttled out to the Comfort. The ship has resources and modern equipment that has never been seen in Haiti. A U.S. Disaster Medical Assistance Team (DMAT) is now set up in the city and it is also well equipped but there is no way to let other areas know it is up and running.

Think of your own city. You may know what is going on within a few blocks, but without communication how would you know what is available 3 miles away? What if you are homeless and hungry and injured? A coordinated crisis would have medics traveling with the U.N. trucks and transporting the injured. The thousands of volunteers should be deployed in meaningful ways to deliver supplies, triage the sick and transport back and forth.

The problem in Haiti now is not lack of medical volunteers. The problem is coordination. I hope the world can learn from this crisis and do it better next time.


14 comments:

Kellie said...

Last night I watched some great informative on line videos on the Comfort floating hospital and also on showing what the crushed injury can do do a person it's affect on the kidneys on;
http://www.cnn.com/2010/HEALTH/01/21/haiti.rhabdomyolysis.crush.injury/index.

It said the Comfort Floating Hospital is the size of Johns Hopkins Hospital.

I also read that some nephrologists are being brought in to work on the kidney problems. Hopefully they can do dialysis on the Comfort.

Toni Brayer, MD said...

Kellie: Yes they do have dialysis on Comfort. Thanks

CountryMidwife said...

I hope the world can learn from this crisis and do it better next time.

Absolutely! THIS is the global lesson of this disaster. SOMEONE needs to be in charge.

Kellie said...

I was thinking about what you wrote: "The last time this many amputations were done was during the Civil War".
After the immediate emergencies and survival crisis is stable I was wondering if they will want PT, and OPT to volunteer to help with rehab. and some prosthetic companies to donate to these amputeed patients? Like companies the VA Hospitals use.

From what I have read and heard it sounds like aumptations had to be done in such a hurry under such tough compromised medial conditions that now there are so many infections from the amputations.

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