“It has been eight days since the devastation struck this impoverished island nation. Eight days. And yet people are being delivered to our hospital in record numbers with untreated infected wounds, open fractures, and crippling crush injuries. As if the injuries had just occurred. I always ask, through the interpreters, how their injuries occurred, and where they spent the intervening days. Invariably walls collapsed upon them, sometimes trapping them for days, and once freed, would spend days in their homes or public dwellings, as there was neither transportation nor secondary care once life-saving measures were successful.
And yet, these are the ‘lucky ones.’ Their countenances reflect the quiet solemnity of survival amidst the horrors of destruction. They come to us, children from ages 2 to 11, elderly women, young men. Quiet, dignified. You can see in their eyes that they are thankful, regardless of their injuries. And many come with extremities having already been amputated.
Our work in the hospital is stratified chaos. We are continually trying to process and understand the nature of the injuries of the incoming individuals. Xrays sometimes take over 24 hours to procure. Triage determines the ability to take the most needy to surgery. Equipment scarcity and time determine, in part, what we are able to accomplish. Finally, supplies arrived yesterday, and the dire need to innovate is not as acute. External fixation of all fractures occurs quickly, debridement of wounds with large areas of skin and soft tissue loss, and infections require judgement to determine if the limbs can be saved.
We are absolutely innundated with patients, sent here as we are the largest hospital with functioning facilities in the country. The people of this city of Milot have rallied to accommodate their bretheren. The schoolyard across the street has been vacated to house the injured. I went on rounds late last evening with a Haitian doctor from the hospital, to see our post operative patients and to assess those who had come in throughout the day. In a room with a blackboard painted on the wall, where once were student desks and chairs, eight thick straw mats provided bedding for the injured. IV’s were hung where once the hands of inquisitive students assuredly were raised.
My last evaluation of the evening was that of a 42 year old man whose story was all too familiar. A wall had collapsed on his right leg where he remained trapped for two days. He had just come to us yesterday afternoon. His leg was twice the size of the other, with blisters, and weeping wounds. He had no sensation nor movement of his foot, and his leg was quite hard and tense. It was obvious that he had what we call a compartment syndrome, where intense swelling occurs in a part of the leg. The pressure increases and prevents blood from entering the leg. Slowly the muscles and nerves die if the pressure cannot be relieved with surgery. Unfortunately, this did not occur, and his entire lower leg is effectively dead. He will require an above knee amputation. With further questioning, I learned that this gentleman is an accountant.
Do you know how difficult it is to achieve an advanced degree in this country, let alone any developing country? At least, with the tragedy of losing a limb, he will be one of the absolute few who have some hope of overriding the sociocultural and fiscal devastation of an amputation and its subsequent disability. He prayed that G_d wound protect him.
While writing this at 6am, just felt a 15 second tremor and shaking of the building housing us. We are 90 miles from the epicenter! Just heard there was no damage in Port au Prince
All for now.
PS- Does anyone know whether rooster is more savory broiled or barbequed? They leave me with only four hours of sleep each night.“