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Haiti: Two Weeks of Emergency Care in Review
February 3, 2010
Haiti 2010 © Julie Remy
As medical assistance moves into a second phase, with conditions finally improving for the practice of surgery and medicine, three MSF staff members describe how the teams treated patients in the ruins of the Delmas district in the immediate aftermath of the January 12 earthquake in Haiti.
The Earth Shakes
The Wounded Arrived Immediately
For two entire days no one stopped, neither to eat nor sleep. The watchmen controlled the surging crowds while a member of the medical staff picked out the most urgent cases. On January 14, even though no reinforcements had arrived, the surgical team started operating in a theater cobbled together under plastic sheeting. In the meantime, in Bordeaux, a field hospital was loaded on a cargo plane for immediate shipment to Port-au-Prince.
Organizing Triage, Medicine and Surgery
A fourth post was set up for triage, identifying serious cases and providing care for dressings and plasters. Off to one side, a doctor was busy suturing. Then there was the monitoring of hospitalized patients. The work took place in the heat and the noise, at times under the light of only headlamps. But at least the sterilization system worked, and the anaesthetists had the medicines they needed in the pharmacy. “I remember one young woman who had suffered very severe head injuries,” recalls Dr. Philippe Touchard, an anaesthetist. “It took three of us to administer the anaesthetic, as her airways for intubation were barely accessible.” Her wounds were in awful shape, he says. “We operated on this 27-year-old woman several times,” and managed to save her life.
Haiti 2010 © Julie Remy
More than 110 procedures were carried out in ten days (without counting the dressings) at the Pacot and Trinité sites, including 27 amputations. Most of the wounded had a crushed limb, or markedly open and infected wounds. The teams tried to avoid amputating if at all possible, but there were cases where it was the only way to save the patient’s life.
A Limb Lost, A Life Saved
Hard decisions had to be made. “My first operation was on a hand, which is my speciality,” Roberto recounts. “It was a gaping open wound, really infected, I cleaned it. I couldn’t amputate. It took me two days to resolve to cut off limbs. I ended up, three days after this first operation, amputating this hand. The infection had set in too deep, and was moving too quickly. The patient risked losing an arm or dying. At the start, I couldn’t announce the amputation myself. But it got easier. It’s not because I got used to it, but I accepted that it was at times the only thing to do, the right decision.” The team “still saved many others–legs, arms, hands,” he adds. In the morning, at 7 am, without saying a word, each doctor would check if his patients were still alive, or had “passed on.” That was the term the team used.
Transfer to the Inflatable Hospital
One hundred patients hospitalized in Pacot and another 80 from Trinité were transferred to Saint-Louis. They found themselves installed on beds with mattresses and without what they feared most: a roof. The canvas structure reassured them while ongoing tremors spread repeated waves of panic. The surgeons started operating in conditions conforming to quality standards. So Joseph agreed to take a break, far away from Port-au-Prince. On January 28, for the first time in 16 days, he stopped feeling as if he was trembling.