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Surgeons Recall Different Experiences in Haiti Following Earthquake

New York (Mar 23, 2010)

Patients outside a hospital after the earthquake in Haiti
A hospital in Port-au-Prince.

Doctors who traveled to Haiti following January's earthquake landed in conditions unlike any they had seen before: thousands of patients inside and on the grounds of barely functioning hospitals, lying on makeshift stretchers – mattresses, doors, crates amid the smell of death and infected flesh, and children awaiting amputations, in some cases of more than one limb. These scenes have left indelible marks on NewYork-Presbyterian orthopedic surgeons Dean Lorich and Joshua Hyman, who trekked to Haiti to help – and who are both planning to return.

Dr. Lorich, who is Associate Director of the Orthopaedic Trauma Service at NewYork-Presbyterian/Weill Cornell Medical Center and the Hospital for Special Surgery, arrived four days after the earthquake with a group of 12 colleagues. The team was flown to Haiti by Synthes, a manufacturer of orthopedic trauma equipment, along with all the orthopedic equipment the plane could carry.

Dr. Lorich operating in Haiti
Dr. Lorich, right, operating in Haiti.

"We were really a unique unit capable of doing surgery with our own equipment," Dr. Lorich said. "We brought our own food, water, on a private plane, and OR equipment with a team. At the time we thought we could run an operating room very effectively." Things were more complicated than they anticipated though. Port-au-Prince General Hospital, where they planned to get to work, had no running water, operating rooms set up in storage closets, and power for the whole hospital supplied by a small generator.

The group rapidly shifted its base to the nearby Haitian Community Hospital, which had operating rooms with running water and electricity – and a thousand or so patients awaiting care. "When we got there we were overwhelmed by the number of patients. Worst of all for us were the kids. Many of them didn't have family, they were just lying on cardboard or a mattress in the hallway waiting for their broken bones to be fixed." Dr. Lorich and his colleagues quickly began operating and continued though the next 72 hours, with short breaks for sleep. The goal of most of the surgeries, Dr. Lorich said, was to salvage limbs. But about 40 percent of the trauma injuries required amputation.

Dr. Joshua Hyman in Haiti
Dr. Hyman in Haiti.

By Monday several hundred patients were still waiting for surgery, but there were open areas on the floor, "and the smell had kind of cleared out," he said. While things were improving inside the hospital compound, they were deteriorating outside. "We were the first hospital up and running with a truly functional orthopedic operating room, so Haitians were taking their family members out of other hospitals and bringing them to us." Throughout Sunday and Monday nights the group heard gunshots outside the hospital. On Tuesday there were so many new patients coming in that the hospital went on lockdown and the crowd outside got very violent.

Dr. Lorich and his group were awaiting two additional surgeons and critical re-supplies slated to arrive on Sunday. The surgeons made it to the hospital but all of the equipment was stolen between the airport and the hospital. "The biggest issue for us the whole time was, we got in, we had no way out," he said. "No security at the hospital. No place to sleep. There was no official organization on the ground to get us assistance, to see what we needed. No one running the show."

Patients outside a hospital after the earthquake in Haiti

After delivering a baby as their final act on Tuesday morning, the group headed back to the airport in hopes of hitching a ride home. "We had the Jamaican military escort us out of the hospital with their M16s, they put us on the back of a pickup truck, and we drove to Port-au-Prince Airport and made our way onto the tarmac and more or less hustled a Canadian cargo plane back to Montreal."

Dr. Joshua E. Hyman, a pediatric orthopedic surgeon at NewYork-Presbyterian/Columbia University Medical Center, arrived to find a more organized setting in which to work. He traveled with a team put together by Project Medishare, a Miami-based group that has been caring for patients in Haiti for the last 15 years. Project Medishare had erected a field hospital in a large tent compound near the Port-au-Prince airport. Four large tents, each about the size of a wedding tent, housed an operating area, a casting clinic, a separate dressing area, and cots for more than 200 patients at any one time. The back third of one tent was the operating room. "In that space we had four folding picnic tables that served as operating tables, and we designated these four spaces as separate operating rooms, one of which was pediatrics. Over several days we ran a full pediatric OR there all day," Dr. Hyman said. Another of the four tents housed the 60 or 70 volunteers – surgeons, anesthesiologists, pediatricians, infectious disease and internal medicine specialists, and others.

Patients outside a hospital after the earthquake in Haiti

During his eight-day stay in Haiti Dr. Hyman operated on 15 to 20 patients a day, and most needed more than one trip to the operating room. "Almost all of the injuries we treated were extremity crush injuries. We did our best not to amputate, but if their leg was threatening their life, or if it was clearly dead, truly necrotic, then we would amputate," he said. "If it was just a severe injury we would do our best to stabilize it and get the wounds under control."

Dr. Hyman's group had systems in place to enable them to function somewhat like a hospital in the U.S. "We'd have rounds in the morning and afternoon, so although there were a lot of patients we knew who they were, where they were, and what their problems were. We had an OR schedule – which would change – but at least we had some idea, first thing in the morning, what to expect. We had wards within these very large spaces, and each patient was given a number based upon their location within the ward."

For most patients, the operation in the field hospital was not the end of the story. One of the biggest problems was where to send patients after surgery, Dr. Hyman said. "It wasn't as though they could go back to their homes." When he was not operating, Dr. Hyman spent hours on the phone working to get patients transferred out of the country. He arranged the transfer of many of the sickest patients to South Florida hospitals, "but no one had any documentation with them so working with immigration was really a big problem."

Medical staff on a runway
Dr. Lorich and colleagues on a runway
in Haiti.

Among the 300,000 injured in the earthquake an estimated 4,000 people eventually required amputation. "Reconstructing these orthopedic injuries, getting people prostheses, rehab, and the psychiatric help many will need will be an ongoing process over the next year," said Dr. Lorich, who plans to return in the next several months. "The window to fix them orthopedically is quickly closing. If we don't many will be left as wheelchair-bound cripples."

Dr. Hyman is planning to return to Haiti this month with physical and occupational therapists, and a prosthetist, a specialist in fabricating and fitting prostheses. "I'm trying to help develop a prosthetic facility in Haiti, which is really going to be necessary in the future," he said.

Faculty Contributing to this Article:

Joshua E. Hyman, M.D., is an Associate Attending at NewYork-Presbyterian Hospital/Columbia University Medical Center and an Associate Professor of Clinical Orthopedic Surgery at Columbia University College of Physicians and Surgeons.

Dean G. Lorich, M.D., is the Associate Director of the Orthopaedic Trauma Service and an Associate Attending Orthopaedic Surgeon at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and the Hospital for Special Surgery. He is also an Associate Professor of Orthopaedic Surgery at Weill Cornell Medical College.

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