Sachita Shah, MD, Emergency Medicine
in Haiti after the 2010 earthquake
Day 1 - Entering Haiti, January 27, 2010
When we flew in on Jan 16th to Port-au-Prince, the destruction was evident in many areas. The hardest hit included Carre Four with crumpled houses, which we could see from the plane. The airport was a military zone, and the UN compound had been crushed, with many armed UN and US military throughout the nearby area and various aid groups scrambling about. We were driven by Zanmi Lasante vehicles to several points, only to find the meeting places structurally questionable, finally ending up in an office where we divided into two teams: Saint Marc and Cange. We were on our way.
The streets were full of people, occasional collapsed houses, and long lines of cars near the scant gas pumps that actually had petrol. We arrived exhausted at Saint Marc and found the house empty-abandoned as people had left in a hurry to get back to PAP to find their families.
At the Hospital—Order from Chaos
Our first couple of days at the hospital were shocking and difficult. We found a dirty, non-functional operating room, and around 200 patients laying on the floors of the wards, 40 with urgent operations needed for open fractures and festering wounds. Flies hovered around our patients’ infected wounds while their families wept around them. Our patients were devastated; many were dying of sepsis, and their urine was turning black from rhabdomyolysis. Over the first two days we created order from this chaos, despite daily issues with security and mobs, lack of water, food and supplies, missing doctors and nurses from the Haitian staff, and no communication with the outside world (no phone service, no Internet). We cleaned and stocked the OR; created a recovery area from a stock room; cleaned and built stretchers; and identified, examined, and comforted patients. We started a triage system, first saving lives, then limbs, then fixing fractures that were stable and cleaning non-life threatening wounds, and finally doing follow up care. We found patients with spinal injuries and pelvic fractures that we listed for evacuation and connected, via text messaging, with the US Navy, who transported them to by helicopter from a nearby soccer field. Things seemed to be working well…
But every day, there were unanticipated obstacles and setbacks, despite our best efforts.
There was the earthquake aftershock that shook our house a couple nights into our stay. We all ran outside, got to the hospital, and found that the OR was damaged and several newly injured patients had jumped from their roofs and windows, fearing they would end up under a pile of rubble.
Two Weeks In—"Gen la vie la dan"
“Gen la vie la dan” means “the life has gone out of it [referring to a limb]” in Haitian Creole. This phrase has been murmured throughout the wards of Saint Marc Hospital too many times over the past two weeks. In our attempt to triage the necessary amputations first, we learned that many Haitians would prefer death to amputation, because the condition and future for the physically handicapped here is severely limited. Many of our patients refused amputations despite the risk of death from infection, their fear driving them to leave for second opinions on the fourth day we were here. Others were resigned to losing their dead limbs. Ania is a 16-year-old girl who arrived in extremis from a crushed right leg, requiring an above-the-knee amputation. As we nursed her in our wards, changing her bandages and learning more about her, she tearfully told us her mother was hospitalized in PAP and had lost both her legs from the earthquake. She had been practicing her wheelchair and crutches so she could get to PAP to find her mother.
On the seventh day after the earthquake, we had five deaths within one hour. Many were likely from pulmonary embolisms, as our patients had not been getting out of bed and moving their limbs, and we unfortunately had no heparin to prevent them from getting these clots. It was devastating to run from dying patient to dying patient with no way to help.
More "Help" Arrives
After local radio stations announced that we needed “help,” we were swamped by the influx of this help and had to sort through what our actual needs were. Daily doctors, nurses, and missionaries came to help, but many had different ideas of what might actually be needed and various amounts of patience to listen to what we had to say. These volunteers sometimes became invaluable, for example the nurses from Florida who worked dawn till dusk in the wound clinic, or Stephanie, the Belgian internist, who lived down the street and helped me run the emergency department, always with comforting words in Creole for the patients. Then there were the not so helpful volunteers whom we had to turn away: a smoking Frenchman with a load of rotting apples he wanted to dump for our patients to eat, and an aggressive group of medical volunteers who arrived a week into our efforts and had questionable values regarding informed consent
The Haitian physicians and nurses took several days to adapt to the influx of people, supplies, patients, and chaos—and it was not really until day nine that we started to discuss roles and responsibilities.
Working Together
The main barrier was explained by one of the orthopods at Saint Marc; they thought we were too aggressive with amputations, and they would have let the limb “turn black” before doing them, even at the risk of losing the patient to overwhelming infection. This is because they, too, believed a limbless life in Haiti was a dismal prognosis. Much education and learning about each other had to take place before we could have a day like today, working together, rounding together, smiling together.
Now, day 12 after our arrival, day 15 after the quake, we are in a transition phase. Despite the body count at over 115,000 and growing daily, many homeless in encampments in Port au Prince, and shortages of food, water, fuel and cash, things are getting a bit better. At Saint Marc Hospital, we have completed over 120 operations, and our patients are now being discharged to homes and shelters. The patients from the earthquake have slowed to a trickle, and a new team of Canadians are here to take over. I am taking the morning off to shower, think, sleep and reflect. The local physicians and nurses have returned to work this week, after grieving for their lost family members and friends. Talk has turned to amputation site molding, skin grafts, prospects for prosthetics donations, physical therapy, and emotional support. Nurses are being trained to turn patients, getting them out of bed into chairs; walkers/crutches are in use, and chronic disease treatment is back up and running. Now it is the aftermath … and it will be a long road.
Life Goes On
When I think about our experience here, I am most struck by the compassion of our volunteers-both Haitian and American—and the resilience of the Haitian people. Their already poverty-stricken lives can endure tragedy after tragedy, but still this morning people are able to smile, play music in the street, and restart choir practice at church. Life goes on…
Sachita Shah, MD, is an Emergency Medicine physician in Providence, Rhode Island.
in Haiti after the 2010 earthquake
Day 1 - Entering Haiti, January 27, 2010
When we flew in on Jan 16th to Port-au-Prince, the destruction was evident in many areas. The hardest hit included Carre Four with crumpled houses, which we could see from the plane. The airport was a military zone, and the UN compound had been crushed, with many armed UN and US military throughout the nearby area and various aid groups scrambling about. We were driven by Zanmi Lasante vehicles to several points, only to find the meeting places structurally questionable, finally ending up in an office where we divided into two teams: Saint Marc and Cange. We were on our way.
The streets were full of people, occasional collapsed houses, and long lines of cars near the scant gas pumps that actually had petrol. We arrived exhausted at Saint Marc and found the house empty-abandoned as people had left in a hurry to get back to PAP to find their families.
At the Hospital—Order from Chaos
Our first couple of days at the hospital were shocking and difficult. We found a dirty, non-functional operating room, and around 200 patients laying on the floors of the wards, 40 with urgent operations needed for open fractures and festering wounds. Flies hovered around our patients’ infected wounds while their families wept around them. Our patients were devastated; many were dying of sepsis, and their urine was turning black from rhabdomyolysis. Over the first two days we created order from this chaos, despite daily issues with security and mobs, lack of water, food and supplies, missing doctors and nurses from the Haitian staff, and no communication with the outside world (no phone service, no Internet). We cleaned and stocked the OR; created a recovery area from a stock room; cleaned and built stretchers; and identified, examined, and comforted patients. We started a triage system, first saving lives, then limbs, then fixing fractures that were stable and cleaning non-life threatening wounds, and finally doing follow up care. We found patients with spinal injuries and pelvic fractures that we listed for evacuation and connected, via text messaging, with the US Navy, who transported them to by helicopter from a nearby soccer field. Things seemed to be working well…
But every day, there were unanticipated obstacles and setbacks, despite our best efforts.
There was the earthquake aftershock that shook our house a couple nights into our stay. We all ran outside, got to the hospital, and found that the OR was damaged and several newly injured patients had jumped from their roofs and windows, fearing they would end up under a pile of rubble.
Two Weeks In—"Gen la vie la dan"
“Gen la vie la dan” means “the life has gone out of it [referring to a limb]” in Haitian Creole. This phrase has been murmured throughout the wards of Saint Marc Hospital too many times over the past two weeks. In our attempt to triage the necessary amputations first, we learned that many Haitians would prefer death to amputation, because the condition and future for the physically handicapped here is severely limited. Many of our patients refused amputations despite the risk of death from infection, their fear driving them to leave for second opinions on the fourth day we were here. Others were resigned to losing their dead limbs. Ania is a 16-year-old girl who arrived in extremis from a crushed right leg, requiring an above-the-knee amputation. As we nursed her in our wards, changing her bandages and learning more about her, she tearfully told us her mother was hospitalized in PAP and had lost both her legs from the earthquake. She had been practicing her wheelchair and crutches so she could get to PAP to find her mother.
On the seventh day after the earthquake, we had five deaths within one hour. Many were likely from pulmonary embolisms, as our patients had not been getting out of bed and moving their limbs, and we unfortunately had no heparin to prevent them from getting these clots. It was devastating to run from dying patient to dying patient with no way to help.
More "Help" Arrives
After local radio stations announced that we needed “help,” we were swamped by the influx of this help and had to sort through what our actual needs were. Daily doctors, nurses, and missionaries came to help, but many had different ideas of what might actually be needed and various amounts of patience to listen to what we had to say. These volunteers sometimes became invaluable, for example the nurses from Florida who worked dawn till dusk in the wound clinic, or Stephanie, the Belgian internist, who lived down the street and helped me run the emergency department, always with comforting words in Creole for the patients. Then there were the not so helpful volunteers whom we had to turn away: a smoking Frenchman with a load of rotting apples he wanted to dump for our patients to eat, and an aggressive group of medical volunteers who arrived a week into our efforts and had questionable values regarding informed consent
The Haitian physicians and nurses took several days to adapt to the influx of people, supplies, patients, and chaos—and it was not really until day nine that we started to discuss roles and responsibilities.
Working Together
The main barrier was explained by one of the orthopods at Saint Marc; they thought we were too aggressive with amputations, and they would have let the limb “turn black” before doing them, even at the risk of losing the patient to overwhelming infection. This is because they, too, believed a limbless life in Haiti was a dismal prognosis. Much education and learning about each other had to take place before we could have a day like today, working together, rounding together, smiling together.
Now, day 12 after our arrival, day 15 after the quake, we are in a transition phase. Despite the body count at over 115,000 and growing daily, many homeless in encampments in Port au Prince, and shortages of food, water, fuel and cash, things are getting a bit better. At Saint Marc Hospital, we have completed over 120 operations, and our patients are now being discharged to homes and shelters. The patients from the earthquake have slowed to a trickle, and a new team of Canadians are here to take over. I am taking the morning off to shower, think, sleep and reflect. The local physicians and nurses have returned to work this week, after grieving for their lost family members and friends. Talk has turned to amputation site molding, skin grafts, prospects for prosthetics donations, physical therapy, and emotional support. Nurses are being trained to turn patients, getting them out of bed into chairs; walkers/crutches are in use, and chronic disease treatment is back up and running. Now it is the aftermath … and it will be a long road.
Life Goes On
When I think about our experience here, I am most struck by the compassion of our volunteers-both Haitian and American—and the resilience of the Haitian people. Their already poverty-stricken lives can endure tragedy after tragedy, but still this morning people are able to smile, play music in the street, and restart choir practice at church. Life goes on…
Sachita Shah, MD, is an Emergency Medicine physician in Providence, Rhode Island.