Global health, plastic surgery and helping in Haiti

Global aid was urgent after a 7.0-magnitude earthquake struck Haiti on the afternoon of Jan. 12, 2010, leaving thousands dead and millions in need of help. The Red Cross estimates that more than 300,000 people have died as a result of the earthquake and subsequent health-related incidents. Up to 50 percent of Haiti’s buildings have been damaged or destroyed, leaving another 300,000 homeless in Haiti’s capital, Port-au-Prince.

As a fourth-year medical student at the American University of Antigua College of Medicine, I wanted to be a part of the relief efforts in Haiti. With support from my mentor and ASPS member Darrick Antell, MD, an assistant professor of surgery at Columbia University in New York, and Peter Bell, MD, executive dean of the American University of Antigua, I was able to join a group of surgeons on a humanitarian mission in February 2010 through the Vanity 4 Humanity relief effort, which was organized by ASPS member Donald Roland, MD. I departed from JFK Airport in New York, and I met plastic surgeons at Santo Domingo Airport in the Dominican Republic. We then drove eight hours to Jimani, D.R., using an iPhone app and the GPS in the rental van. Wild bulls and other animals roamed freely, and very few roads were marked. Only half were paved.

During the month prior to our arrival, medical teams had been treating hundreds of patients at The Good Samaritan Hospital in Jimani, about 40 miles east-southeast of Port-au-Prince. The observed patient population was 40 percent children with a constant influx of new patients.

Desperate conditions

Before the earthquake, Haiti was already the poorest country in the western hemisphere. More than half of Haiti’s 9 million people lived on less than $1 a day (presumably even less now), according to the United Nations World Food Program (WFP). Half of Haiti’s population had no access to safe drinking water before the earthquake.

After the earthquake, conditions grew increasingly desperate as emergency field hospitals and tent-city refugee camps emerged. A base hospital was established with the arrival of surgical and medical teams from the United States and other developed nations.

The most common procedures included placement of external fixators to stabilize fractures, debridement, amputations, skin grafting, burn care and orthopedic intervention. A greater number of minor surgical cases and an increasing number of infectious disease cases prevailed. The hospital had the only C-arm radiological device in the country – it’s difficult to import technology even in good times.

The most complicated cases – those patients requiring specialized instrumentation to address maxillofacial trauma – were stabilized and evacuated by helicopter to the USNS Comfort, a 500-bed naval hospital ship anchored in Port-au-Prince Bay.

The Haitian medical system in Port-au-Prince was devastated and ill prepared to handle the tens of thousands of injuries. There are currently organizations opening rehabilitation centers, and international rehabilitation experts are assessing the needs. We helped secure supplies and trained Haitian occupational and rehabilitation therapists.

Heartbreaking scenes

Children separated from their families were commonplace – as were unaccompanied children requiring above-the-knee amputations. A tearful, frantic father speaking only French arrived searching for his daughter. With her picture in hand, the man claimed to have walked 30 miles on a fractured leg while checking every hospital along the way. Unfortunately, neither the hospital’s patient list nor a walk through recovery tents found his daughter, so his search continued.

We saw infants abruptly separated from their injured mothers faced malnutrition due to the lack of breastfeeding (a peculiar cultural stigma of breastfeeding being associated with a lower societal function was alleviated through a volunteer lactation specialist). Perhaps the most heartwrenching moment was seeing a critical infant transported to TGSH presenting with enlarged liver, respiratory distress and acute loss of heart rhythm. After 30 minutes of resuscitation attempts, the child was pronounced dead.

Every case was sobering – and identifying and reuniting children and families still needs sustained effort for injured children and separated families in Haiti.

We found an even greater shortage of medical relief workers per earthquake victims that existed in Port-au-Prince. As we reached the heart of the city, a greater volume of destruction and chaos was apparent. When a videocamera was stolen – taken directly from our hands by a local – had us immediately questioning our safety. Hiding the rest of our equipment from view we drove, inching through in an increasingly dense sea of displaced thousands, where only a respectful “pardon” or “merci” encouraged the reluctant to move from our vehicle’s path – allowing us a safe return.

Since structural integrity of other hospital buildings was questionable, nightly clinical follow-ups were conducted outside and under courtyard tents at TGSH.

Concerns for the weeks and months following this trip included prevention of HIV, cholera, plague and tuberculosis outbreaks. There also exists the consequences of flooding of the tent cities set up during rainy season, improper sewage drainage and the lack of clean water for drinking and bathing. The complexity and depth of these ongoing and increasingly deteriorating matters can be mitigated, if not reversed, through international involvement.

Three years later

Much progress has been made, though the work is far from finished. According to OCHA, continued support is needed:

The rebuilding of Haiti will require years of international help.

Epilogue

Post-earthquake Haiti was akin to being in a war-zone. Resilience and the patience of the Haitian people, politics and international cooperation to rebuild amid the chaos, clarified the importance of global health and relief efforts. Surgery’s role was exemplified by plastic surgeons and their selfless treatment of burns, wounds, complex abscesses and ulcers; infection prevention; restoring range of motion and articulation; and cancer and crush injury treatment.

Global international health care through humanitarian initiative proved extremely challenging. Ultimately, it’s humbling yet an honor to have an opportunity to make a difference so directly to so many – to help instill hope, faith and even smiles amid such pain, hardship and disaster.

As a medical student, it was immensely satisfying to have played a meaningful role with a team of plastic surgeons doing such priceless work, and I hope to do so again – though hopefully, not as a first responder to a catastrophe – as a future plastic surgeon.

Editor’s note: Three years have passed since the January 2010 earthquake that left Haiti’s capital of Port-au-Prince in rubble. Though scores of physicians and allied medical personnel traveled to the country to provide emergency care, the nation still functions in crisis mode. Medical student Abhishek Parikh, MS, has written this article to keep the still-urgent medical needs before the public – and ASPS member surgeons.