Haiti: 4 months post quake - The Milot Perspective

4th August 2010


The desire to help following major disasters is often present. Sometimes it is also a question of how one can help practically, and how this may happen. A team of us from Morriston Hospital, Swansea set about looking into ways in which we could contribute our combination of anaesthetic, orthopaedic and plastic surgical skills.

We came across the CRUDEM foundation which is an American Foundation working in partnership with Haitian staff to provide medical and surgical facilities to the population of a small town called Milot, approximately 80 miles of North of Port au Prince. Prior to the earthquake, weekly teams of volunteers would visit the hospital, training and supporting the local staff and also bringing in specialist services. Hôpital Sacré Coeur (HSC)  had 73 beds.

Inside MASH tent

Whilst the earthquake of Jan 2010 destroyed major parts of Port au Prince and its infra structure, other areas of the country were unaffected and were therefore able to offer help. Consequently, the bed numbers at HSC increased from 73 to around 400 in very little time. Many patients were received from the Hospital Ship Comfort. Large MASH style tents were erected in the grounds of the school opposite and the classrooms were also used as accommodation.

The Swansea team consisted of  David  Williams, Clare Ware (consultant anaesthetists) , I (consultant plastic surgeon). We joined up with a  larger multinational and multidisciplinary team, mainly American. Our team was scheduled to work in Milot between 15 and 22 May - 4 months post quake, in the rainy season. We had the advantage that we were used to working well as a team together, although we could not fully anticipate what we would encounter. We also had fewer patients to manage as many had been discharged - there were only 110 remaining when we arrived.

In many ways we had it a lot easier than those who had gone out to Port au Prince immediately after the quake. Although basic by Western standards, the hospital was relatively well equipped - and we had safe food , water and showers. Prior to making a trip like this, you wonder if there is going to be enough work- our fears were unjustified and we worked from 8am - 10 /11 pm most nights. Work was not confined to theatre but also included clinics, ward rounds and seeing emergency referrals. It soon became apparent that there was much operative work to be done and we set about prioritising the more complex cases and those which would need several trips to theatre in the 7 days in which we were there. We did not wish to start a treatment plan and not be able to complete it.

There was also a need for us to accomplish as much as we could in the week as there was not another orthopaedic/plastic surgical team scheduled for a further month.

Despite having defined roles in the UK, we all had to be flexible, and often scrubbed to assist in each other's cases. We had access to one theatre and procedure room  most of the time  - the other theatre in the hospital was kept for emergency and elective obstetrics and gynaecology cases. Thirty-eight orthopaedic/plastic surgical cases were performed in the week. In terms of the earthquake patients these ranged from relatively simple cases such as external fixator removal to more complex cases such as limb salvage requiring soft tissue cover and bone transport techniques. The more complex cases are being followed up through email communication with Haitian staff. As well as limb salvage cases, other patients also benefitted from secondary reconstruction to improve hand function - a procedure that could only be offered as we knew that there would be a steady stream of physio and occupational therapists over  the coming months. Although the impetus had been the desire to help following the quake, we were surprised to find that approximately half of our operating time was spent treating other complex trauma patients or advanced soft tissue tumours.

It was good to work alongside the Haitian staff - some of whom are the hardest working and humble individuals I have ever come across. There was a little time available to train and leave some skills behind, but unfortunately, the busyness of everyone inevitably meant that training opportunities were not maximised. Four months post quake, the acute surgical need has subsided considerably. No doubt there will be a steady stream of patients who present at some time in the future with osteomyelitis, or other conditions requiring secondary reconstruction, but  this will be difficult to measure as patients get lost to follow up and have to contend with a Haitian health system in desperate need of support.

Portering in the rain

The needs of Haiti are vast and almost immeasurable. One hears of the death toll following the quake (250,000 - 300,000) , the fact that approximately 1 million people are still living in tents, and the fact that all that people have in hospital is often the bag of personal possessions by their bedside. When the many have been fitted with their prosthetic limbs, they will no doubt be discharged back to the devastation and violent city  that is Port au Prince. They will leave the relative safety of Milot and start rebuilding their lives . In the reality of life outside hospital, they will have to cope with their disability, a tarpaulin sheet for a home during hurricane season, grief from the loss of many loved ones...  Yet the Haitian patients still give us foreigners a smile.

We went back to our homes, to our families. This, is humbling.

Haiti is not making headline news anymore, but the needs continue and will continue for many years. As well as the reconstruction of the medical infrastructure, there is a need to train Haitian surgeons in Plastic Surgical techniques so that they have the skills to treat soft tissue trauma and tumours.

We may hear about disasters and wonder if our contribution can help. It can. It may not be about saving many lives, it may not be about heroics, and it may not even be about going. Helping one person move forward following the disaster may not seem an efficient use of resource, but for that individual patient it can mean the world.  We all have a role to play, whether it is employers releasing employees to go, giving to aid organisations, or going ourselves. One of my new American friends said that it was the "best week of his professional life". I agree.
Please remember Haiti - the story continues...............


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