Saturday, February 27, 2010

A hard road, but we're moving forward

January 22…
There was incredible activity in the compound today at the University Hospital. We suffered through more aftershocks and had to permanently evacuate a large building, so once again patients were outside in the brutal heat. Under tarps and rapidly deployed tents, we treat them with fluids and attend to their now week-old wounds.

The days are nonstop from dawn to dusk. I am now assuming a role to help organize the operation, including the logistics of water, food, sanitation, operating room needs and schedules. I’ve been coordinating volunteers, arranging for shelter, caring for orphans, and interfacing with the military. The enormity of suffering is beyond comprehension, but we are learning to comprehend it and must move forward. I have learned as much as I have contributed, so that I will be prepared for the next days and the future. The people with whom I’ve worked, from Haiti and all other nations, have been incredible. We are becoming a family.

Today’s story is about a 5-year-old survivor of a week beneath the rubble. He was pulled from the ground and came to our team emaciated, dehydrated, frightened and confused. Our doctors and nurses gently hydrated him and started him on the road to recovery. With so many people affected, there will be many such stories, but for each tale with a happy ending, there are thousands with a tragic outcome.

January 23…
We saw a lot of progress today at the hospital. The surgeons are seeing a decrease in the number of patients that need emergency surgery for crush injuries and fractures, but that doesn’t mean that we are anywhere near a point where less-than-massive resources are needed. There are countless broken bones, deformities, facial injuries, and burns. We are encountering the sequelae of the initial surgeries that were performed in difficult settings. These mostly include infections that require wash-outs of wounds and revisions of the prior surgeries. This is to be expected in our situation. The U.S. military has given the hospital tremendous support in facilitating the transfers necessary to the USNS Comfort hospital ship.

The hospital campus is evolving with some decent structure. We now have a central pharmacy, three operating rooms for adults, one operating theatre (within a tent, as are most facilities) for children, and arrangements for childbirth, children, postoperative patients, and emergency triage assessments. These are crowded and extremely busy areas, staffed by dedicated physician, nurse and technician volunteers. We are moving toward 24- hour coverage.

I spoke with a young woman today, a dancer in Haiti who lost part of one of her legs. She was brave and doing her best to cope. I told her that she will dance again, and that she will be a much better dancer on one leg than I could ever be on two. She smiled and squeezed my hand. These are such special people. I have not seen one seriously injured victim complain. 
I am now tasked to coordinate the medical activities of all the non-governmental agencies within the compound, so I am working on medicine, essential services like water, food, and sanitation, integration among services, creation of satellite pharmacies, placement of physicians and other volunteers, and many other activities. I have never worked so hard, but have also never been more focused. My job is to make the situation improve every day for these people and for this country. The International Medical Corps team has performed tirelessly and without a whimper, and has set an example of what can be done when you are on a mission and go after it with all of your heart and soul.

January 24…
It was incredibly hot today on the grounds of the hospital. Fortunately, we have erected sufficient tents to accommodate all of the patients. We estimate that we have more than 600 patients on the grounds now, either in tents or living in a communal central area we call “the forest.” While there has been considerable progress, we have a way to go with communications (no phones yet), sanitation, information distribution, acquisition of key equipment, and development of social services like mental health.

We continue to have new patients enter the compound, including nearly 100 emergency patients today. We are receiving patients referred from the countryside and other hospitals. The operating rooms are busy with orthopedic and wound care, skull fractures, hand surgery, facial reconstruction, and the like. Neurosurgery is still not ready to go at this facility. 
The Swiss have a pediatric surgery service next to our pediatric area. The tent ward is full of children with multiple amputations and severe injuries. There is no candy coating this – their lives will never be the same.

A half a block away, when the wind shifts, it smells of death from as many as 100 bodies buried in the rubble of the nursing building. We have learned to adapt, to walk past this place and wrinkle our noses. We no longer need to wear facemasks. 
To facilitate progress, we have selected a chief of surgery and a nursing director, and have begun to make the nights as well staffed as the daytime.

I have to sneak away now and again from my organizational duties, to see patients and be a doctor. There are many doctors here to help, and we are grateful to have them. The emphasis now is to quickly transition this medical center back to its rightful owners. 
The city has been flattened, but the people are now picking up the pieces. We notice a decrease in the amount of garbage in the streets, and vendors are springing up selling fresh foods. The food drops have been very successful. 
I found someone willing to trade a hotel room shower for a medical consultation. Even though there was almost no water pressure and no hot water, it was the most wonderful shower I have ever taken.

Dr. Paul Auerbach
Photos by Margaret Aguirre

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