Cath Lab Digest

Dr. John Macdonald arrived 2 days after the earthquake. With more than 10.5 million
people affected (240,000 died in the first hours), considering population and country size, it is believed to be the greatest, recorded, natural disaster in history.

In the hastily created University of Miami tent hospital, in the first hours, we had 7 physicians, no nurses, and minimal medical supplies for 150 + patients — men, women, and children, many sudden orphans. Without the most basic of medical supplies, our small team, collectively, was overcome by a feeling of worthlessness. As we moved from patient to patient, we quickly addressed blood-soaked improvised dressings, cardboard splints, crushed limbs, cluttered waste-stained floors, and flies. In the beginning, our only analgesic medications were tablets of morphine. Our most important support was the adequate availability of IV fluids.

Immediately, it was apparent that a structured wound team was an absolute necessity. The majority (80%) of the patients brought to our facility had open wounds, crush injuries, and compound fractures. We performed our first amputation outside the medical tent, using Versed (Roche) and Ketamine (Pfizer). Our approach to wound care was to stick to the basics: debride, keep the wound moist, provide betadine and/or peroxide, and use antibiotics, Coban (3M), and Silvadene (Monarch Pharmaceuticals). Silvadene became like gold. KCI was overwhelmingly generous, providing as many as 30 negative pressure therapy systems to run on generators. Because of a lack of sterile instruments and basic sanitation, closed fractures were treated with external fixation and plaster splints when possible. Cholera and typhoid were ever-present, growing concerns.

The wound care program and the orthopedic service became the central active services. In the first 2 weeks, we had the luxury of two to three knowledgeable wound clinicians and they would train volunteers from every specialty to become members of the wound care team; eight to 13 team members were working 12-hour days. Living conditions were very difficult— initially, we slept on the floor of the medical tents, mostly consuming only water, granola bars, and cold, canned chicken soup; we were forced to use ditch-plowed latrines. There were three outside showers for 80 medical personnel.

And then, hour-by-hour, day-by-day, the madness began to resolve and some order overrode the chaos. Incoming supplies, skilled volunteers, surgical suites, cots, and tents for the faculty were appreciated improvements. A life was saved, a wound properly dressed, a better selection of Granola bars, available (if disgusting) port o’ potties! The medical teams were functioning as organized divisions. Finally, critical patients were allowed to be evacuated to the States and the positive faces of the US military working beside us filled us with American pride.

In the beginning, the medical teams sensed a feeling of helplessness and many felt personal spiritual despair. But soon, the negative emotions of the first days became, for us, a soft, energizing nirvana that originated in the resilience and faith of the Haitian people with their striking acceptance of suffering and expressions of unconditional gratitude for any measure of care. And at night, when the wards would fill with Creole singing “Jesus, thank you for loving us,” we wept together.

For the volunteers, our lives became situated in the Here and Now. Nonessentials disappeared. The prevalent atmosphere became joyfully resourceful, generous, empathic, and brave. The ache of existential despair was replaced by a spiritual grace derived from human hope, generosity, and solidarity. We had a glimpse of who else we can be and what else our lives and our society could become. We had a sense of membership in something special — being human. We were each our brother and sister`s keeper.

We knew we had to bring some order to the disorganization; we felt strongly that we had to get the Haitian people involved in our efforts. We met with the Ministry of Health who told us to select 10 doctors and 10 nurses from Haiti. Within the next few months, the World Health Organization (WHO) will send a team to provide a 3-day seminar to train clinicians in basic wound care. Our endeavors will become the first focused wound care program developed for natural disasters.

You will hear more about our efforts in Haiti at the SAWC in April and in a feature article to be published in the fall.