Sunday, January 31, 2010

Two Separate Cities

Nearly three weeks after the Jan 12th earthquake, Port-au-Prince has become two separate cities. In one, the bustle of daily life slowly resumes. In the other, an endless swath of rubble, partially collapsed buildings, with roofs awkwardly canted, remains frozen in the moment of Haiti’s worst nightmare. It is dead.

In the living Port-au-Prince, petty traders have returned to the streets, selling just about everything from sugar cane to cell phone batteries. In the morning freshness, before the heat sets in, women carry buckets filled with the day’s supply of water on their heads back to makeshift shelters that have sprung up on sidewalks, in parks, football fields and other once-open spaces in the city. Men carry wooden poles, doors, and slabs of corrugated metal rescued from the rubble to build new, temporary homes.

At the main university hospital in downtown Port-au-Prince where International Medical Corps doctors and nurses tend the injured each day and the seven mobile clinics in outlying areas where we also work, earthquake-related wound care is now mixed with the complaints of everyday medicine. Patients awaiting aftercare of earthquake-related wounds wait patiently next to headache sufferers.

Rubble has been cleared from most of the streets, traffic moves—or doesn’t. The influx of international aid groups, United Nations agencies and a small army of media have only added to a gridlock in central Port-au-Prince that was notorious before the earthquake. As darkness falls, the streets narrow further as city residents use white cinder blocks and chunks of concrete rubble to carve out their sleeping spots for the night.

And all around them the dead city of Port-au-Prince remains. Schools, hospitals, office-buildings, hotels and endless private homes squat lifeless and quiet--flattened into a fraction of their former size. That many are mass graves only magnifies their stillness.

Sometimes the two cities meet. Sunday morning two housewives living in a tent camp across from the collapsed Presidential palace found a practical use for iron rods from the fence that once protected the palace: the iron rods now serve as a clothesline.

Saturday, January 30, 2010


By Tyler Marshall

Port-au-Prince, Haiti -- On a small hill in the hard-hit Petionville area of the Haitian capital, International Medical Corps operates a mobile clinic to treat the 20,000 residents of a provisional tent and plastic-shelter community that has sprouted up in the days since the Jan 12th earthquake.

Residents are mainly those who lost their homes in the earthquake.

On Saturday, International Medical Corps volunteer physician, Marie-Alixe and volunteer critical care nurse, Simone, worked with Haitian physician, Charles and a team of Haitian nurses to treat about one hundred residents of the new community. Both Marie-Alixe and Simone are Haitian American.

Working with local counterparts, they conducted basic wound care to keep injuries sustained during the giant quake on the mend and other, more routine treatments. By the time the clinic opened, a large crowd of about 60 or 70 people, primarily women and children, had formed at the entryway, waiting their turn.

The mother of a 1-month-old, for example, expressed concern about her infant’s cough while an older woman complained of shoulder pain in what may have resulted from sleeping on the bare pavement of the streets.

As with other International Medical Corps facilities, two trends visibly underscored the gradual reduction of acute cases and the rise of more routine complaints:

- a higher percentage of those seeking treatment for non-urgent ailments.
- an increasing number of Haitian health professionals showing up in ever greater numbers.

The goal, said both International Medical Corps volunteers, was to work closely with local Haitian health care professionals so that they could eventually transition to take on greater responsibilities.


In Medical Parlance it’s called “Revising”

In medical parlance it’s called “revising” – adjusting and hopefully improving—an original treatment. Two-and-a-half weeks after the earthquake there is a spike in the number of revisions in clinics and hospitals in the Haitian capital as medical practitioners work in calm conditions to smooth out or repair procedures undertaken in the chaotic first hours and days following the quake - sometimes by people with little or no medical experience.

Perhaps the most unusual case was a woman who came into an International Medical Corps mobile clinic during the past few days, with a severe head laceration, bound together with her hair, wrapped into a knot at the time and sealed with Super Glue.

“A perfect solution in emergency conditions,” said Emilie Calvello, who teaches Austere Medicine at Johns Hopkins Department of Emergency Medicine. The revision included cleaning and stitching the laceration closed—and removal of the Super Glue.

A middle-aged man at the same clinic underwent a revision procedure to remove an inch square chuck of concrete that was sown up into his scalp on the first night after the quake.

Work is also required to revise what one physician called guillotine amputations--where the leg is taken just above the ankle rather than below the knee--because it is faster and easier to perform. Often more of leg must be taken in order to facilitate cleaner healing.

Monday, January 25, 2010

“It has been the longest week in years.”

By Dr. Solomon Kuah
Monday, January 25, 2010 7:55 PM,
Port-au-Prince, Haiti

It has been the longest week in years. As the dust settles we find ourselves in a 'second' disaster - the thousands of NGOs, volunteer group/individuals, journalists, celebrities and political entities in a backdrop of tons of materials and supplies, both useful and useless. In this, our team has established itself as the leaders in clinical health care by being the first to deliver and the one to coordinate the only semi-functional hospital. Well . . . it is a tent hospital. There are 11 tents/wards, with nearly 500 beds, and 2 more tents coming. Our International Medical Corps team has grown with fresh faces and clean t-shirts - a contrast to the now rag-tag appearance of our original team. Most of the new volunteers have enlisted to run mobile clinics and outreach and see mostly primary care. In the hospital it is a different story. Imagine Port-au-Prince on a good day, now we are in post-disaster. We see 300 patients a day and do EM/trauma in 2 tents. Again, the dust is settling.

We lead and 'coordinate' approximately 50 teams/NGOs working to establish a functional tent hospital. We receive large amounts of resources from the Clinton foundation, USAID, Sean Penn and Wyclef Jean; I've met them both. We've created standard registries to keep track of our patients and conduct epidemiologic studies in this mess of a response. We've actually had a few patients disappear, yet the clinicians are very reluctant to adopt the registry, but we'll continue to push the importance.

Despite trying to coordinate all this I get to see some patients. I've had multiple GSW's (I haven't seen a gunshot wound since being at CU) and a Typhoid perforation. I have a skateboard coming in from one of my local translators, this should make me more mobile to accomplish my coordination tasks, then can I get back to patient care.
Tomorrow is another day.

Tuesday, January 19, 2010

“You need to remind yourself that your skills and equipment are not the solution...”

By Dr. Solomon Kuah

Tuesday, January 19, 2010 10:42 PM,
Port-au-Prince, Haiti

I've questioned myself and the skills/sensibilities of an EM physician in extremely chaotic, austere situations like acute phase disasters. You need to pack light, get out there and determine what needs to be done. You need to remind yourself that your skills and equipment are not the solution. You need to remember when you go home their world and bodies are still destroyed.

Our team is a clinical powerhouse. Lead by the tremendous father figure and wilderness medicine genius, Paul Auerbach. Our role model and sergeant is Stanford chief of EM, Bob Norris. Stanford wilderness medicine and Columbia international EM fellows march to their guidance and try to work one to two steps ahead. This could be the dream team of clinical disaster response.

However, this is not enough. ER intake, three wards, and 2 ORs later we are overwhelmed with thousands of rotting wounds, open fractures, crushed femurs, and maggots. We ran out of ketamine and narcotics twice already - those days you could hear the screams outside the wards echoing louder through the compound. Another supply of ketamine and narcotics would arrive - enough for a sigh of relief and then we'd run out again.

We can only prioritize open septic fractures to the OR. The remaining, who would easily go to the OR in the US, are admitted for their daily morning shot of rocephin. They wait for their operation, and are still waiting. We put them in traction and debride their wounds at bedside. I've only put in 2 styman pins in the past, I've now increased that by 10-fold.

I will never forget one patient’s bruised, swollen smile as maggots crawled out of her gums. I will never forget the smell of oozing, rotting flesh. I still hear the screams of pain on the days we were out of narcotics - you don't have time to wait. I will never forget the young girl who reached to touch my face, only to realize that her arm was gone. She cried and said thank you, that she loved me. I will always remember singing to a 2-year-old child to distract her from the compound's tornado of noise, devastation, and tragedy. I sang the same song a dozen times as my arms trembled in our 1-mile hike to the pediatric ward - she weighed over 50 lbs in her bilateral lower body spica cast.

Tomorrow is a new day. I will take comfort in a clean set of clothes as I sling over my shoulder 2 jump bags which are spilling over with materials for fractures, wound care, and pain control. Tomorrow we will work.