Healing Haiti: Call for Papers

It has now been two weeks since a catastrophic earthquake hit Haiti and the situation is dire. In addition to inviting several physicians who are working in Haiti to submit updates to Annals’ blog, Annals editors are reaching out to experts in a variety of fields to solicit manuscripts that address the immediate and long term challenges as well as critically examine how this crisis may influence internal medicine in coming years.

The official death toll is already over 150,000 and thousands more are disabled by head trauma, amputated limbs, post traumatic stress disorder, and other critical injuries. The city of Port-au-Prince lies in ruins and the relocation of hundreds of thousands of its inhabitants to rural areas or to other countries is underway. As time passes in crowded camps without adequate shelter, sanitation, food or clean water, survivors are at increasing risk of life-threatening infectious diseases. Supply chains of vital HIV and TB medications have been interrupted. Even before this disaster the people of Haiti suffered greatly from untreated chronic conditions such as hypertension and diabetes.

Trained health care personnel were in critically short supply before the earthquake and it is not yet known with any accuracy how many Haitian physicians, nurses and other health care workers perished when the quake struck. We do know that surviving Haitian medical personnel, joined by trauma and orthopedic surgeons from all parts of the world, have worked heroically under unimaginable circumstances to save as many of the injured as possible, in many cases while they were grieving the loss of their own family members. As the efforts of these true professionals to find and treat the acutely injured wind down, the focus must now shift to the equally urgent mission of addressing the long-term medical needs of the Haitian people.

The earthquake destroyed most of the hospitals in Port-au-Prince. While there are some viable healthcare facilities in the country side they were neither designed nor staffed to handle the great numbers of patients now coming to them. There are insufficient supplies of even the most basic of medicines. Subspecialists simply do not exist. Internists in Haiti and all over the world, joined by their colleagues in pediatrics and family medicine will have to provide the critical backbone of long term medical relief, providing primary care in the truest and purest sense of the word.

We hope to engage a discussion that will help foster the development of plans to address the short and longer-term health needs of Haiti such that the future is not only brighter than the present, but even more promising than it was before disaster struck on January 12. Over the next 6 months, we welcome the opportunity to consider for publication thoughtful commentaries, original research articles, and scholarly reviews that inform the question, “What can we do to help heal Haiti?” Please direct inquiries about potential submissions to Dr. Deborah Cotton at dcotton@acponline.org.

HIV clinic GHESKIO in Haiti

We have lost many friends in Haiti. Our HIV clinic GHESKIO has been transformed into a refugee camp, field hospital, and continues treating thousands of people with HIV and TB. The Haitian doctors and nurses are amazing. They have been at work since day 1. It has been overwhelming.

Dr. Dan Fitzgerald, GHESKIO clinic in Port au Prince and Center for Global Health of Weill Cornell Medical College in New York; he has worked in Haiti for 15 years;

Medical Care in Haiti

The rudimentary level of medical care in this poverty stricken country can only be appreciated by directly experiencing it. The ability to obtain any advanced diagnostic studies is extremely limited. There is essentially no critical care services in the 200 bed hospital we are based at. The concept of a post-anesthesia recovery unit is non-existent. Simple interventions for patient safety such as oxygen monitoring are again, extremely limited.

The majority of the patients we are currently taking care of have sustained crush injuries to the extremities. The orthopedic surgeons are busy stabilizing fractures, and the general/trauma surgeons are managing complex wounds. The nurses have established a make-shift recovery area which can serve as a potential critical care area as well. Our ability to provide even basic level of care is handcuffed by a lack of supplies. Basic things such as IV equipment, oxygen regulators, pulse oximetry, casting materials are needed badly. There is no role for advanced interventions here. Although our immediate goal is providing life and limb saving care, we are also trying to provide sustainable care that can continue once these incredible relief efforts ease.

We are truly honored to be taking care of such a humble but proud people. Thank you.

Rajan Gupta, MD
Team Leader, Dartmouth Haiti Relief Response Team One
Director of Trauma, Dartmouth Hitchcock Medical Center