Medical Teams International has vertually taken over King’s Hospital in Port Au Prince. Thus relieving the local staff, which has been seriously overworked the last several days, to tend to their own families and needs. It is a brand new hospital that was just getting ready to open. Although many of the walls in the hospital have large cracks, engineers from the UN certified the building as “safe” – whatever that means – the day before we arrived. We immediately set to work to organize the two operating rooms (O.R.s), unpack supplies and equipment and get the O.R.s setup for the surgeons by noon.
We roped off the front of the hospital to control access and triaged patients in the courtyard outside the hospital. Patients with minor injuries were treated and released from outside. Patients with more serious or critical injuries were prioritized and brought inside the hospital for treatment. Inside the hospital we ran 3 exam/ treatment rooms. Each patient came in with a piece of paper with their name, age, and chief complaints listed. We would remove their bandages, clean their wounds, re-examine their injuries and re-splint/ bandage their wounds. Critical patients would be “admited” to the hospital for surgery and the more stable patients would be asked to return in one or two days to have their wounds re-cleaned and dressed or return with an x-ray (if broken bones were suspected – and if the breaks were not obvious), as the hospital had no radiography equipment.
The injuries, in general, were extremely similar from one patient to the next. Crush injuries, multiple fractures, and full-thickness skin loss, paricularly to extremeties. Almost without exception every single patient had a severe infection (pseudomonas or gangrene) of their open injuries. Necrosis (dead skin) was not uncommon. The mechanisms of injury (MOI) were always the same as well. The language barrier (we were working with translators – some more skilled than others) did often make it difficult to determine exactly what happened or to get an adequate description to what exactly caused the injury (which is helpful to rule out other injuries). Out of habit we would ask, but the response was always: “A brick…, a wall…, a house… or something heavy… fell on me.” In some cases, they didn’t know what hit them.
The pain and agony that these people were in was very clear, and every one of them had been waiting patiently for care (for nearly a week or over a week in some cases). The vast majority of them never made even a slight whimper. There was an occasional scream or moan when a bandage was removed, or when an obviously broken bone was moved. But the strength and bravery of these hurting people was an amazing thing to witness. It was the same among young and old, no matter how severe their injuries were. One woman had both a clearly fractured humorous (upper arm) and a clearly fractured femur (upper leg) and yet she never screamed. Two children on the first day were brought to us by their mothers both with femur fractures, neither one even whimpered or cried. Very few had had any medications beyond an ibuprofen or Advil. Antibiotics were limited, but were provided to almost every patient.
I cannot even begin to tell you what it is like to watch a 25 year old man be told that he is going to lose his leg below the knee and then to have him genuinely thank us for being there and helping him. Over and over, everyday that I was there, patients would receive the devastating news that their leg, arm, hand, thumb or toe would have to be amputated. I never heard anyone ask “why me”. The abbreviation BKA was a common phrase used by the nurses and doctors all around the hospital. I learned that this stands for Below Knee Amputation. Once the orthopedics begin to finish their work, there is going to be a huge need in Haiti for prosthetics. It was also clear that the surgeons were doing everything in their power to not amputate unless it was the only option. If there was a possibility that a surgically debridement would clean out the wound sufficiently and that there was still hope of saving the limb, they would always do that first.
My role varied during those four days that I was in country and working in the hospital. Although I was typically only assisting one of the doctors or nurses, organizing medical supplies (which were arriving constantly), or serving as a “gopher” to go get something, I was really fortunate in that I got to experience many different aspects of patient care throughout the hospital. I learned techniques of removing bandages (as EMTs we are trained how apply them, and in experiencing how they are removed I have learned which applications are more humane). I learned how to debride and clean wounds. I assisted the doctors and surgeons in the operating rooms, and I assisted Kathi (the physical trainer) in teaching post-op patients how to walk with a walker or crutches (which were in very short supply – if not non-existent altogether). I was the scribe, writing down the patient’s vital information, as we attempted to develop some sort of patient charting system to document and keep track of the patient records and their care. I did whatever was asked of me and whatever needed to be done.
On Wednesday morning (1/20) our team was awaken at 6am by a significant aftershock. I was asleep at the time, as were many others. I was sleeping on a matress on the floor, but I guarantee you I have never gotten out of bed so fast in my life. When I returned to the room after the quake, I was puzzled that I could not find the sheet that I had been sleeping under. I found my sheet on someone else’s matress over halfway across the room. All I could think about while the building was shaking were the horrible injuries that we had been treating for the last several days caused by collapsing concrete buildings, like the one I was sleeping in. All of the bedrooms were on the second floor, so we all had to go down a flight of stairs to evacuate the building. When we got back to the hospital we found all of the patients outside in the courtyard. On Thursday we had a few more smaller tremors at noon. Ironically, I was in the process of trying to comfort a patient who was trying to flee the hospital because she did not want to be inside.
Post traumatic stress is clearly present in most of the patients, and even those not injured. The injured people are deathly afraid of being indoors or inside of a building that may collapse on them. Many would agree to come inside the hospital for treatment, but refused to remain inside. Those that are not homeless because their house did not collapse are homeless because they are afraid to be indoors.
Please continue to keep the Haitian people in your thoughts and prayers. They have a long road to recovery ahead of them. Thank you for your thoughts and prayers for me and the other medical professionals that I went with. Please continue to pray for them as most of the doctors and nurses are still there and will be for the next several months.
The following video shows a tour of King’s Hospital given by Dr Dan Diamond the leader of our team with Medical Teams International: (If you watch the video closely, you will see me briefly at about 2 minutes and 47 seconds.)
http://www.ustream.tv/recorded/4127362
The following link is Dr Dan’s blog address:
http://www.powerdyme.com/dan-diamond-powerdyme-blog.html
The following link is Andy Davidson’s blog (his Day 1 post uses two pictures that I took). Andy arrived the day before I left:
http://orhospitals.wordpress.com/
Young boy with femur fracture in operating room.
One of many cracks in the hospital walls.
Triaging patients in the courtyard.
Treating patients after triage.
Treating patients after triage.
Thank you for your thoughts, prayers, and support.
