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)