Dr. Hyman's Haiti Journal - Day 9: Catastrophe to Chaos
Posted Jan 23 2010 7:15am
It is nine days after the quake, and last night three gaunt Haitian medical students, their school destroyed, came up to me in the dark as I walked past the nursing school with 150 nurses still buried in the rubble, the smell of rotting flesh floating in the hot, heavy evening air. They have helped out for the last week at the hospital but had no food to eat and only a little water to drink. Their homes were destroyed and most of their families were dead. Yet they showed up to help. They came to me to ask if they could get a job, a way to feed themselves and what family they had left. But the hospital's personal system is not functioning yet. Our first priority has been saving lives.
I went to get them food; high-energy biscuits (dry cookies) that were dropped off by the World Food Program too feed 5000 people on the hospital campus for five days. The food has been dropped off, but is locked behind three doors and there is no clear distribution system yet. It took me two hours to get them food and then find some more food for the new group of surgeons, doctors and nurses that arrived from Children's Hospital in Boston for Partners in Health. The three medical students slept out on the ground, with home to go back to, and with food in their stomachs for the first time in a week.
The first day we arrived at the abandoned hospital save for Dr. Lassegue and Mrs. Thompson, the director of the General Hospital and his administrator. Our small group of seven, the first to arrive, built five operating rooms and with the help of a few other small groups who arrived the next day, we created a functional, if primitive, surgical hospital. We have now seen every one of the 1000 or so patients that were strewn about the hospital grounds under the hot sun, amidst flies and maggots, and we have operated on about 200 of them.
But yesterday was a watershed. There were no drapes, supplies, gloves, masks, and surgical bandages when we started in the morning two days ago. But yesterday we received a flood of supplies and people. To build the hospital infrastructure with 1,500 employees, volunteers and workers with systems for personal, supplies, food, water, sanitation, power in less than a week is monumental task. When it has to be done in a system that at its best was a disaster makes it near impossible, but in Haiti, every day, the people live and do the impossible surviving wounds, trauma, and burdens unimaginable to most the rest of the world. We now have hundreds of doctors and nurses from around the world, aid workers and supplies. Dr. Paul Auerbach, emergency physician from Stanford University is doing a super human task of organizing the entire medical and professional staff in flux moment to moment into a cohesive unit, creating order from chaos. He is working closely with Dr. Telemark, the chief of surgery of the hospital. It is the beginning of creating order from chaos.
The next phase will be coordinating the activities - logistics, infrastructure, and organization. After the setback from the second quake, yesterday we made progress. Claire Pierre and I and Dr. Benjamin from Mount Sinai, met with the Minister of Health and the head of disaster relief. There are poor communication systems all across the country, most destroyed by the quake, with email or cell service often down. So we drove to their new headquarters in an automotive parts building to explain the needs of the patients and hospital. I have been coordinating with General Keen and Colonel Gibson and the Joint Task Force Surgeon, Dr. Ellison, to get support from the military for medical evacuation and logistics and support. I explained to the minister that the military was willing to give their full support but needed a helicopter-landing zone near the hospital and approval for full logistical support for humanitarian aid.
I pulled out my iPhone and gave the General's email address to the Minister of Health and he composed an email giving him full permission to help. I read the email and wept with relief, knowing we could save hundreds more patients. He feared displacement of the people camped in the nearby stadium. In every open space in the city, 3 million Haitians sleep outside on the street afraid of being in the buildings. After the quake two days ago, fresh amputees hopped on one leg out of the post-operative wards fearing their lives. But the President and the Minister welcomed the Navy helicopters to land at the Palace grounds close to the hospital to evacuate patients from the hospital to the USS Comfort, a 1,000 bed hospital ship. The Palace is collapsed like a big meringue pie.
The next morning a man came in with a traumatic head wound and with the new team from Mount Sinai headed by Michael Marin, he had 3 intravenous lines started and his head wound covered and then we quickly transferred him to the waiting FLA (front line ambulances) from the 82nd airborne. I jumped in the back of the dark, hot sweatbox of the ambulance carrying 4 stretchers and loaded with patients, continued to help him breathe with an ambu-bag. We made our way 500 yards to the Palace grounds and offloaded him to the helicopter. I hung his intravenous fluids on a carabineer and kneeled over another patient trying to hold on the door as the helicopter lifted off and whisked us off for the 5-minute flight to the USS Comfort hospital ship. We landed on the deck, a team of navy sailors took him to the emergency area where a team of doctors and nurses were waiting on the ship capable of taking 1000 injured patients. After making a quick assessment of the ships surgical capabilities, I jumped back on the chopper, a bag of peanut covered M&M's in my pocket, given to me by a sailor who thought I looked hungry. I was. In the heat of temperature and activity, eating and drinking are secondary which is good, as I don't have to worry about where I will go to the bathroom.
But today, Day 9, there is no sanitation at the hospital campus, and Captain Ramos, who is in command of the 70 soldiers from the 82nd airborne, who have been there for three days, is worrying about the health of his men and women. General Keen came yesterday and I asked him for sanitation, but there are no port-o-potties available in the country and only a few latrine kits. And disease is breaking out - not just wound infections, but also tetanus and meningitis are breaking out on the hospital campus.
A group of Spanish rescue workers have begun removing the 150 dead nurses from the nursing school. One worker came into speak to Dr. Lassegue about where to place the corpses. They were placing them in large garbage bags and wondering how we could identify the bodies. The bodies were often in parts and only a few had identification on them. How do we name the lost? The woman's whose house we are staying at, Micheline Rampy, had lost a close friend, Allain Rolan Rocourt, who died in the first moment of the quake as a beam fell on his neck. He was found still sitting at his desk. He had a funeral, but what about the lost and nameless bodies piled by the thousands shoveled by front loaders into dump trucks, what about the nurses in the bags in the morgue with no names?
Now the hospital has supplies and people, and we have created a functional hospital within a week. But there are still thousands who have not been seen laying in the streets, fractures and wounds unattended with no transport that will bring a second wave to the hospital. The Haitians with resources and money, and local businessmen and women are mobilizing 10,000 people with transportation to go out into the communities to find the lost and wounded and bring them to get care. But as of yesterday all the hospitals are full in the country, and this morning when I arrived back at the hospital, the Palace landing zone was closed for patient transport because of a food drop for the tent city in front of the Palace.
There were two more small aftershocks this morning and all the patients ran, hopped or were dragged from the building screaming. In the hot sun the intensive care patients felt safer than in the buildings even though they risked death from dehydration. And though more tents were put up yesterday, there are still too many in the sun. All the buildings are again empty after enormous efforts to get the inspected and patients moved back inside - and we struggle to find open ground on the hospital campus to put more tents. Larry Ronan, MD from the USS Comfort came to find a place to put a mobile post-operative ward. But the only place was the ground greasy with fat and body fluids from the hundreds of dead bodies that lay there just a few days before. How can we place a post-op unit in front of the morgue where the stench still hangs thick in the wet Caribbean air?
Yet we are only at the first phase of the catastrophe. Next we have to find a way to care for the patients discharged from the hospital who will need care for months, and those who will need rehabilitation after losing their limbs. And there will need to be help for the estimated half million homeless, half million who will have to be displaced from their homes in the streets and tent cities to rebuild Port au Prince. It may be even more because almost all of the three million in this city are sleeping in the streets and parks, afraid to go back in their homes. Every other building has collapsed in the city. There is a saying that the Haitians are not afraid of war or earthquakes or hunger, but they are terrified of rain. And soon the rains will come.
Once the immediate life-threatening needs are met, the psychological trauma and support and re-building of communities will need to happen. As we drove through the rubble of the city to the hospital this morning, a woman was screaming and writhing on the cement in an alley, grieving and expressing the anguish felt by millions here and around the world.
Friends and people are calling and asking how they can help. This country needs help and not just now but for a long time. If you can volunteer for an organization that has a coordinated infrastructure and have useful skills, they will need help for years. But the most important thing that is needed is money and lots of it to help care wounded and traumatized.
The organization best connected and on the ground for 20 years before the earthquake and who will be here for the long haul in Haiti is Partners in Health that has worked closely with the Haitian government to build 10 hospitals all over the country and build community health infrastructure. Most of the other NGO's will come, provide relief and leave. But the Haitians will need help for a long time!!
So please donate to Partners in Health now at www.pih.org. We need $10 million or more just to rebuild this hospital. If every American gave $10 we would have $3 billion dollars to help this country. I have never met a people so full of heart and resilience and kindness and who have suffered so much. The pain they suffer here is beyond anything I have seen yet there is barely a scream or whimper from any of the patients, even the children as we change their dressings or move their twisted torn bodies. Today, amidst the mangled limbs, tetanus, and chaos (which is a step up from the catastrophe of the last week), a young woman caring for her mother, stopped to paint her toenails bright red and smile. And a little boy ran alongside me, smiling, and drinking a little water finally.