Tuesday, May 4, 2010

Early Disaster Response in Haiti: The Israeli Field Hospital Experience

The Israeli relief effort in Haiti was widely praised for its efficiency and organization. Today Annals publishes an essay by team members describing the effort and lessons learned from the experience. Read it now.

Friday, April 16, 2010

Disability Legacy of the Haitian Earthquake

Annals recently published an essay in which Dr. Lisa I. Iezzoni and Dr. Laurence J. Ronan describe how Haiti's earthquake caused untold numbers of new disabilities across the age spectrum, from infants and children to elderly individuals. Read it now.

Tuesday, March 2, 2010

Report from US Navy Ship COMFORT

Today Annals published an essay in which Dr. Edward Miller and colleagues describe what it is like to practice internal medicine aboard the US Navy Ship COMFORT in the aftermath of the Haitian earthquake. Read it now.

Thursday, February 18, 2010

I Had to Go to Haiti

Today Annals publishes an essay, A Doctor Heads Home to Haiti, that describes the experience of Dr. Lionel Malebranche as he returned home to Port-au-Prince to find his family and help the sick and disabled. Read it now.

Tuesday, February 9, 2010

Children and Families

We are starting to see the progression of disaster-related injury and illnesses, among the usual mix of patients that present to the hospital. The disaster-related orthopedic injuries are just staggering. The hospital is full of amputees and severe long bone fractures requiring external fixation. Now, approximately 3 weeks after the earthquake, many of these injuries are starting to heal. Children are smiling, walking around, as they get their hardware removed. However their adult counterparts are not so quick to recover; many remain immobilized and bedridden. We continue to see patients return for wound management, although many of them are slow to heal. Among the more interesting diagnoses we have made directly related to the disaster and wound infections is tetanus, which many of us have never before and will likely never again see in our lifetime. In a poor underserved country like Haiti, vaccinations are rare, and we have to entertain entities in our differential diagnosis that most of us have only read about, like tetanus, diphtheria, and measles.

Tropical diseases unrelated to the disaster are still common, particularly malaria and typhoid fever. In the hospital where I am working we have cared for 4 cases of bowel perforation secondary to late-stage typhoid, a rare but severe complication of this illness. Tuberculosis is rampant, with at least 2 pediatric cases and an entire tent full of adults. Thankfully cholera, one of the most deadly diseases in tropical regions, has yet to emerge. However the poor sanitation and crowding present in most communities here has many of us fearing that cholera will arise during the second phase of this disaster, with potentially fatal implications.

Beyond the severe injury and illness, the most difficult aspect of healthcare in the disaster setting is seeing the families. Nearly every patient has lost at least one family member. Parents are at the bedside of their children, sleeping on the concrete next to their beds, trying to stay close to them at all costs. Many have no where to go and discharging a patient is a challenge, as many people do not have a home to which they can return. A quick look around Port-au-prince demonstrates both the severe destruction and the fear that the earthquake of January 12th has brought to this country. Many homes and buildings lay in ruins. Although some homes appear to be intact, most Haitians are terrified to sleep in these buildings; instead, they set up tents and huts outside in the streets.

Dr. Rakesh Mistry
Division of Emergency Medicine
Children's Hospital of Philadelphia (CHOP)

Thursday, February 4, 2010

Notes from the Field

Reposted with permission from
Caritas Christi Relief Efforts

Tuesday, February 2nd
Betsy Cobb, PT from Saint Elizabeth Medical Center

Day 3 has been long but very rewarding. Dina and I worked from 8A to 7P with an hour for lunch/recharge. We eyeballed pretty much all the patients in the new hospital (around 100 to 120 people) and physically saw 40+, ranging from people with arm or leg amputations (some people with multiple amps), fractures of arms and legs, and pelvic fractures, people who are now paraplegic, and crush injuries (no broken bones, but their nerves and muscles are severely damaged). There is a pediatric unit that another PT is at that has approx 40 kids, an ICU with 6 patients, and the ED which is ever growing, now has more than 100 people in it now that 2 other PTs are at. The whole hospital census is up to 300, and we expected to get 30-40 new patients tomorrow by helicopter.

The doctors in charge say they are capping the census at 400 once the 6 field hospitals are fully up and running.

We are quite tired but it is so amazing how grateful these people are for anything you do for them.

And the community has really rallied around the patient, feeding them, bathing them and providing clothes for them, when they themselves have so little. Many patients are here alone, but you would never know it since there is always someone sitting next to them, caring for them.

Here is a picture of what room b of the new hospital looks like. There are about 30 women in this room. Almost all of them have at least one family member, and the rooms are approx 60 ft x 30 ft. People are on mats on the floor or cots and have a foot or less of space between them.

There are some very sad parts of the day, like when we need to help the wound care team roll a patient who is paralyzed so they can clean the three large wounds she has on her side and bottom because she has just been laying still for 2 weeks. Her prognosis is poor because the type of care she needs just doesn't exist here.

But there are also a lot of bright points in the day, like when one patient cheers on another while they try and walk for the first time after they had their leg amputated, or someone is finally able to walk out into the fresh air for the first time since they arrived at our hospital 2 weeks ago.

In the past few days I have definitely noticed more people outside the wards during the day walking around with their crutches or getting pushed in wheelchairs. In the women’s rooms, there has been hair braiding, and I even saw some girls getting manicures and pedicures.

People appear to understand now that just because they can move around doesn't mean they will get kicked out, and are being proactive in trying to regain their mobility and maintain their health. I can't even fathom what these people will do for work, everyone in Haiti was some sort of laborer before the earthquake, now many of them are missing limbs.

It's amazing the type of care that we take for granted in the US.
On a side note, I had goat for lunch, and I believe also for dinner. Turns out it was quite tasty!

Crutch training begins

Tuesday, February 2nd
John Arcuri

These photos were taken during a medical relief mission in January from the 20th thru 28th in Milot, Haiti about 70 miles north of Port au Prince where it is believed almost 200,000 people perished in one of the most devastating earthquakes in history. Most of the pictures are taken in Haiti at the Hopital Sacre Coeur which is supported by CRUDEM (website and show the hospital expanding from 73 beds to over 300 beds in a matter of days. I met many wonderful people including the Hatian people who were incredibly caring of their fellow Haitians.

I saw many horrific injuries, compounded by the fact that treatment was delayed by many days after the event. The injuries were long bone fractures, many of them open, severe pelvic fractures, spinal cord injuries with paraplegia, nerve injuries from prolonged compression, gangrenous limbs requiring amputation, deep, infected wounds, renal failure from crushed muscles, tetanus among many others.

The people were stoic and grateful for the care we were able to provide, in many cases because of lack of basic infrastructure markedly different from American hospital care.
Life has changed for many there, and the problems will continue as long term care, rehab and prosthetics are non-existent. We discharged very few from the hospital because they had no place to go-they were orphans in their own country.

Caritas Christi has purchased and shipped down several MASH-style tents, self-contained hospital wards which will house additional patients. Images of the tents as they went up can be seen below:

Friday, January 29

We live in a different world. We expect all will be well and healthy and we can accomplish all things. That is not the real world in Haiti. There is pain and suffering and death. We can’t fix it all but if what we do relieves some pain, calms some fear, saves a limb or maybe even a life it was worth the trip.

What we have seen and done in this past week will not fade from our memories a week or a month when our concerns are more inwardly focused and selfish. I hope we have brought back home in our minds and remember what is still here, what will not go away and what we will never forget. We are so blessed and so obligated to share those blessings. Kevin O’Donnell, MD.

One of the most remarkable things I saw while here was how a group of so many people could come together from all over the US and work with each other so well. In such a desperate situation, things could have gone hopelessly wrong, and yet things have miraculously gone very well. Diane Koch, OR scrub and materials.

It has been an amazing experience to be part of the Caritas Christi team here in Haiti. We literally hit the ground running and within minutes of landing, every member of the team was deeply involved in the management and care of hundreds of seriously injured patients. As the days evolved, the team, working well with teams from other parts of the country, developed an impressive system of patient care. It has been an exhausting and at times heart wrenching experience, but I am very proud of the performance of every member of the Caritas team. They truly stepped up and delivered when needed. Rocco Cioccia, MD, Chief of Vascular Surgery, Saint Elizabeth Medical Center.

My experience in Haiti will stay with me forever. The poverty and degree of human suffering was staggering! Yet, patients were so grateful for anything that was done for them. Although exhausted, I go to bed at night knowing I really made a difference. I’m glad I had this opportunity to help all these people. Matt Casey, PA, Carney Hospital.

I cannot ever express my gratitude to the Caritas Christi team from CEO on down for this amazing effort to help this proud, poor and now damaged people. You should see the industriousness of these people. Teenagers in Red Cross vests racing to the copters for patients bent over. Teams of local and dispossessed women arrive en masse and start at room one undressing and washing and feeding ALL the patients. Volunteer translators run from doc to nurse helping. Father James and local ministers comfort the sick, the dying and the families.

One can only imagine what the Haitian people could actually accomplish if given half a chance. Hopefully the world will afford them this chance.Tom Curran, RN, Good Samaritan Hospital

Wednesday, February 3, 2010

Christiana Care in Haiti

I am Dr Lionel Malebranche from Christiana Care in Delaware. I am originally from Haiti and recently had the opportunity to go back to Haiti and help in the relief efforts. The situation was very critical for the capital Port au Prince. At the small hospital where I worked in Santo, we saw about 80 cases a day and were overwhelmed with all the trauma cases we received on a daily basis. The country didn't have any structure to welcome such mass casualties. The people were grateful for every little gesture of love done on their behalf and didn't expect any relief from the current medical system. I was really touched to see hundreds of people sleeping on the ground or under tents. People were scared to go home. Many youngsters would come and ask me if it was ok for them to have palpitations. I saw hundreds of people coming with PTSD, depression and anxiety. Many more lost their hands, feet or part of their limbs. I saw a dozen people who were paraplegic and an unfortunate boy who was tetraplegic and died in respiratory distress since we couldn't ventilate him. This is a very sad situation and everybody's help is more than welcome as the Haitian people are in dire need of assistance especially today.

Lionel J. Malebranche, MD evaluating a patient with an open fracture of her left foot

Lionel Malebranche and 2 Dominican Physicians dressing an open
tibial/fibular fracture prior transferring him to Dominican Republic.

Lionel Malebranche consulting patients at a Jehovah's Witness
Kingdom hall in Port au Prince 6 days after the earthquake.

Total building collapse in the capital Port au Prince

Dr. Lionel J. Malebranche
Resident in Internal Medicine
Christiana Care, Delaware