|Trip Report Dr Andre Vulcain • Jan 12-20, 2010|
I traveled to Haiti the same day the earthquake stroke. I landed in Port au Prince at noon and my plan was to go the same day to Cap Haitien, where we are operating our program.
Because of the bad weather conditions in the Northern part of the country, I decided to spend the night in Port au Prince and to fly the next day to Cap. I checked-in at the Visa Lodge Hotel, in the vicinity of the International Airport at about 2 pm.
I was in my bedroom at the hotel when the earthquake hit. Fortunately, for me personally, it was more of a big scare than real harm. I was emotionally shaken but physically fine.
The hotel was also fine. Overnight, various reports coming from outside of the hotel started to mention widespread destruction and many deaths. The next day, I actively looked for my immediate relatives and I toured the city to have an idea of the damages. My relatives were OK, even though my sister- in- law and my niece came out miraculously of the rubble of their heavily damaged home with some mild to moderate contusions. People on the streets were shell-shocked and some neighborhood looked like they had been bombed. Dead people were lying on the sidewalks and the valiant Haitian people, in an impressive demonstration of solidarity and compassion, were the first bare- hand responders without support or guidance from the authorities, trying frantically to extract some unfortunate victims from the rubble. Some of them died hours after been removed from the collapsed houses without a modicum of medical assistance.
On Post-Earthquake Day 2, I ended up in Delmas 75 at my aunt’s house . I got the news of the UM hospital by the airport being set up, but I couldn’t reach them due to a lack of fuel in the vehicle I was using and the chaotic traffic on the roads leading to the airport.
I heard about an orphanage providing care to the victims at walking distance of where I was staying. I went there and I met two Haitian doctors who were working there since the morning (an orthopedist, Dr. Paul Pelissier and an anesthesiologist, Dr. Gabriel). They live in the neighborhood. Several Haitian medical students were also there to help. We quickly surveyed the place together and assessed the supplies and meds available. Fortunately, the orphanage looked pretty well stocked, by Haitian standards, in some basic supplies and 2 American missionary nurses offered their generous help. Some young Haitian volunteers came to help with the logistics. When I arrived, there were about 50 patients crowding the small courtyard of the orphanage and 2 rooms converted in Pedi wards. More patients were waiting outside desperate to get in the courtyard to have some medical attention. For the next three days we basically worked days in and days out, doing splinting and casting closed fractures, reducing dislocations of limbs, setting “creative” traction systems for alignment of displaced fractures, suturing wounds, debriding infected wounds and opened fractures, watching suspicious abdomens, providing IV and PO hydrations to those who needed it, as well as pain medication (mostly oral), performing supra pubic taps for patients with pelvic fracture and bladder retention (very difficult to find a Foley catheter). The owners of the orphanage were tending to the spiritual needs of our patients and providing much needed psychological support as well as food. Our team was, by luck, highly complementary and just after a couple of hours we were working effectively and efficiently focusing on the goal of helping our unfortunate brothers and sisters.
On Post-Earthquake Day 3 and 4, we had to perform 2 amputations (upper arm and forefoot for severely infected wound and sepsis). Those procedures were basically life- saving interventions for quasi-gangrenous limbs. We used some basic suture kits and some godsend hemostatic clamps and suture materials. We had to use also some additional non-surgical instruments to perform the procedures. I went fishing for them in the toolbox of my cousin where I was staying (saw etc…). We made sure that all instruments used or to be used went to a three-stage process of sterilization (bleach solution, boiling and betadine bath). We also performed two fasciotomies for compartment syndromes (limb saving). The anesthesiologist did a very good job providing pain control through regional blocks. Diclofenac IM worked miracle for pain control in the post-op. My surgical training and experience that preceded my dedication to Family Medicine were definitely helpful in these particular circumstances.
Our major surgery patients (amputees) were free of complications on their 3rd post-op day with stumps showing signs of great improvement. We discharged them with antibiotics and instructions to report to another facility as our “clinic” was closing shop after we took care of about 100 patients .We had no death of patients who made it to our “facility”.
On Post-Earthquake Day 5, I made a first trip to Leogane .We had received bad news from the area and I was especially touched by the situation. I found the city where I grew up almost totally destroyed with limited assistance after 5 to 6 days. My colleagues Dr. Guy Craan, a Haitian physician and a Public Health specialist had talked to me over the phone and made me aware of the situation and we decided to start a care unit there jointly with a team of Haitian and Cuban doctors already in the area. I went back to Port au Prince (by that time I had some diesel for the vehicle I was using) and I got a good amount of medical supplies from the UM hospital by the airport which we loaded in a pickup truck. Two Haitian physicians joined our team. The post is up and running now as a multinational care unit at the entrance of Leogane.
I left Haiti 2 days ago and I am planning to return next week.
Recommendations for medical teams:
1- The following specialties are the most needed: orthopedists, general surgeons, anesthesiologists, family physicians and ID specialists, counselors for emotional support, trauma and emergency care nurses, infection control nurses.
2- Small and well balanced teams of physicians (3) and nurses (3) adjusted to the level of care of the setting, can provide efficient care, if supplies and proper logistics are available. It’s good to have some information on where the teams are going and tailor the teams based on needs.
3- Some temporary hospitals will keep operating for months. After the acute phase, there will be a need for other specialists ( internal medicine , pediatrics , psychiatrists , and rehab specialists ) to provide treatment for common illnesses, follow-up for post-op patients and attend to the needs of the amputees.
4- Port au Prince, Delmas, Leogane and Jacmel are places to consider. It’s possible to piggy-back on existing units of care to enhance their ability.
5. Medical supplies and equipments needed:
• Casting supplies
• Traction equipments
• Splints (all kinds)
• Foley catheters
• Straight catheters
• Sutures material
• Minor surgery instruments
• ACE bandages (3” 4” 6”)
• Kerlex bandage
• Sterile gauze 4x4
• Iodoform gauze
• ABD pads
• Metallic boxes for instruments
• Gloves sterile and non sterile
• Surgical masks
• Gigli saw
• Bone rongeur
• Urinary bags
• Irrigation syringes
• Sterile draping for surgery
• Vaseline gauze
• Pain medications (NSAIDS and others)
• Local anesthetic agents (lidocaine, bupivicaine)
• Antibiotics: Penicillin oral and IV, doxicyclin, ceftriaxone, gentamicin, metronidazole, bactrim, macrolides, cloxacillin, clindamicin
• IV fluids (D5W, lactate ringer, normal saline)
• Anti allergic (diphenydramine and others)
• Topical antibiotics (Neosporin cream, etc…)
• Tetanus immunoglobumin and tetanus toxoid
• Silvadene cream
• Hydrogen Peroxide
• Betadine solution
• Lindane cream
• Sterile water
• Sodium chloride solution for irrigation