PORT-AU-PRINCE, Haiti Scott Plantz, MD, a member of Gannett Healthcare Group, publisher of Nursing Spectrum and NurseWeek magazines and host of Nurse.com, was in Haiti Feb. 19-23 to volunteer at a hospital for survivors of the earthquake that left hundreds of thousands of Haitians in need of care. He is a clinical associate professor of emergency medicine at Chicago Medical School. He is the author and editor of more than 20 medical textbooks, co-founder of the American Academy of Emergency Medicine and a senior vice president of Gannett Education. He practices in Florida and Texas.
Twenty years in inner-city EDs, I thought I had seen it all until … Haiti. Flying in you feel like you are being dropped into a war zone helicopters, tents, military vehicles, cargo boxes and searchlights.
In Port-au-Prince I worked at Project Medishare and the University of Miami Global Institute hospital located 200 yards from the runway at the Toussaint L’Ouverture International Airport. The earplugs my wife tossed in my bag turned out to be a major lifesaver.A corner of a tent serves as the neonatal ICU established by Miami Children’s Hospital.
At first I thought I had arrived in chaotic hell. I soon learned I was working at the best-organized, best-manned and well-stocked hospital in Haiti.
I worked in a 10-bed ED with dirt floors, no privacy curtains and one trauma bay. Patients were taken care of in outdoor tents or either the medical, pediatric or surgical wards. There is an intensive care unit and a large operating room with plank wood floors. The operating room has four teams. We had a lab, pharmacy and an X-ray machine.
Staff accommodations included one large air-conditioned tent and multiple small tents. We slept on cots and even had electricity, phone and Internet connections. There were outdoor showers and toilets. I was working in the lap of luxury compared to my colleagues at other facilities.
We had water and food, most of the time. Protein bars and military MREs (meal, ready-to-eat) were the staple. Hot meals consisting of rice and beans showed up intermittently.
In the ED I saw patients whose wounds ranged from crush injuries, to acute gunshot wounds, with a sprinkling of tropical diseases. ED residents and nurses asked, “What’s this?” Invariably it was an end-stage clinical finding you never see in the United States. Malaria, tuberculosis, typhoid and parasitic diseases were common. Patients who looked to be in their 70s turned out to be 40.Outpatient wound care supplies occupy a section of the hospital tent.
At this stage in the quake aftermath the trauma usually came from recovery attempts or fights over food and water. One child had fallen off a 15-foot wall. His father carried him on his back 20 miles to our ED. There was no neurosurgeon available for his head injury. Fortunately, he did well.
The medical-surgical ward would take your breath away; all patients in row after row of cots 12 inches off the floor. The back ward had a row of paralyzed patients. Being a quadriplegic is a serious problem in the United States; it is a death sentence in Haiti. One man, paralyzed from the chest down, arrived with both legs rotting off.
Haitian families lived all day in 100-degree heat in tents across from the ICU. Anywhere you looked was a patient with broken bones being wheeled around in makeshift wheelchairs. They were the worst injuries I have ever seen. Bones were literally crushed. Even with the best orthopedic surgeons, repair was often impossible. Wounds, some infected, got great care.Pam Louderback, RN, a nurse practitioner from Florida, volunteered alongside Plantz in Haiti. Watch for Louderback’s reflections on the disaster on Nurse.com.
I was called to assist in the care of a patient found buried in the rubble. Needed intravenous supplemental food and vitamins, which proved to be unavailable. He doesn’t seem alive skin and bones, barely coherent. I am sure he will die.
The United Nations was an oasis not far from camp. Identify yourself with medical ID and they let you in. There is a restaurant with hamburgers and beer. They even have showers and flush toilets. There are tons of people hanging out. Major subject of conversation is, “What in the hell is the U.N. doing?”
Patients are arriving by foot and oxcart and the U.N. has at least a hundred unused vehicles and a dozen helicopters flying around dignitaries with no thought apparently given to providing medical transport.
The most frustrating problem is little communication between hospitals. At Medishare we had four orthopedic surgeons with light surgical loads. We found out just down the road they were sending patients home with femur fractures who were told to come back in two weeks. No central organization is helping to manage the supply of health professionals.
The entire country was overpopulated before the earthquake; things are now a hundred times worse. In the past we have provided immunizations, clean water and medical care, but the problem is you end up with 9 million Haitian people with resources that might support 1 million.
Returned home feeling we made a difference, tired and a bit frustrated. Plan to go back soon.