“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.