One year on from the catastrophic earthquake that devastated Haiti, we look at the experiences of medical volunteers Saqib Noor and Professor Ian Pallister in the weeks and months after the disaster
Staff and patients at the Haiti Hospital. Photograph: Christine Finn
An estimated 250,000 Haitian men, women and children tragically lost their lives following the earthquake of 12 January 2010. Rescue teams from across the world fluxed into the country in a desperate attempt to assist 300,000 injured patients and over one million displaced people.
As the world’s media beamed heartwrenching images of the destruction in Haiti’s capital city Port Au Prince and celebrities rallied for fundraising, the injured patients began their journey into the chaos of post-earthquake Haiti. Many patients were relocated to the north of the country, a distance of approximately 100 miles from the epicentre of the earthquake but an eight-hour drive by road.
"The number of patients in Milot swelled to 450, with the hospital taking over adjacent school buildings"
The Haiti Hospital Appeal (HHA), a UK-based charity established in the north of Haiti for a number of years had been constructing a maternity and paediatric hospital. Suddenly, with little infrastructure, scarce medical resources and medical staff, the HHA found themselves treating severe spinal injuries. In February 2010, Mr Saqib Noor travelled with a medical team including one nurse, Rachel Smith and one physiotherapist, Joanna Woodrow along with Christine Finn, a journalist, to assist with the care of these spinal patients.
The team arrived at the hospital near Cap Haitien to hear the stories of 18 paraplegic and one quadriplegic patient on the hastily furnished, austere, make-shift wards, known as the ‘Spinal Unit’. One woman lost her husband, her child, her parents, her brothers and sisters, her home whilst simultaneously sustaining a complete cord injury at the level of L1.
Most patients had been found hours to days post-injury, one quadriplegic man being trapped under rubble for eight days with a cervical spine injury whilst rescuers could only feed and water him. The patients were evacuated to a tented medical camp in Port Au Prince before being transferred to the US military medical ship, the USS Comfort. From here they were transported to the north of the island and eventually on to the Haiti Hospital via the Hopital Sacre Coeur, a Catholic missionary hospital and the largest non-governmental hospital in the north of Haiti.
From the moment of trauma to arrival on the wards of the Spinal Unit, most patients had been neglected due to the overwhelming number of injuries and fatalities, thus developing severe complications, including very large grade 4 sacral decubitus ulcers. The wards were small, the beds were basic and electricity and running water were intermittent at best. Despite the atrocious conditions, outstanding care was delivered in a warm and positive atmosphere. Fiona Stephenson, a wonderfully energetic British nurse from Salisbury had been working on site for the previous two weeks, establishing the back to basics nursing care these patients desperately needed.
Patients were being administered with low molecular weight heparin, having regular hourly turns, daily (albeit basic) dressing changes and as optimal analgesia as available (no stock of analgesia for neuropathic pain). Medical notes from the emergency teams in Port Au Prince in a variety of languages including French, Russian, and Spanish were consolidated into a daily record management plan and scattered radiographs for each patient were carefully filed.
Despite their loss, the patients were happy and hopeful. Patients and their families would sleep on the ward, developing camaraderie like no other, cleaning and cooking for each other – carers helping those with no remaining carers. Our team of one doctor, two nurses and a physiotherapist saw them daily, improvising with what appliances and kit we had to solve problems and begin the rehabilitation process.
Initially, there were no spinal surgical expertise but a team from the US arrived at the Hopital Sacre Coeur where operative facilities were available. Patients were reviewed by the spinal surgeons and transferred via helicopter to the operating theatre for spinal stabilisation or plastic surgical procedures. The Hopital Sacre Coeur was transformed into a bustling tented field hospital, filled with multiple orthopaedic injuries, amputations, external fixations, wound infections and soft tissue defects. Orthopaedic surgeons were rotating through this hospital on a two-weekly basis from the US when Saqib Noor helped to organise a trauma surgical team of one complex trauma surgeon, one plastic surgeon and two anaesthetists from Morriston Hospital, Swansea, to assist with the orthopaedic problems developing after acute injuries.
In May, surgeons Ian Pallister (Complex Orthopaedic Trauma) and Ian Josty (Burns & Plastics) along with anaesthetists David Williams and Clare Ware set out to join American colleagues at the Hopital Sacre Coeur in Milot to form ‘Ortho Team 15’. Much had changed since the early days after the earthquake. Helicopter pilots had originally been guided to Milot with printed Google earth images. The number of patients in Milot swelled to 450, with the hospital taking over adjacent school buildings. By May, the peak of the emergency activity was over, and the earthquake in-patients numbers had reduced to around 110.
Day-to-day care was provided by rotating teams of physiotherapists and nurses, mostly from the US, but with vital input from UK and Commonwealth volunteers. One of whom, Joanna Woodrow, had originally arrived in Haiti in the same team as Saqib. The continuity provided by Joanna and her counterparts was essential. The routine use of helicopter flights was soon to cease, so there was a focus on transferring spinal trauma patients before they would have to endure lengthy road journeys.
Many patients had external fixation performed for open fractures, or required amputations and were awaiting limbfitting. Another US charity had converted a banana lorry container into a fully equipped limb-fitting centre. Again, serviced by rotating volunteer teams, these patients’ needs were slowly but steadily being addressed. Local volunteers were also being trained so that the service would be assured of out-living the international volunteer effort.
An initial ward round guided by the established volunteers required Team 15 to split up to review 110 patients in one afternoon, identify those requiring surgery and prioritise according to complexity. Only two of the Team 15 volunteers had previous relief work experience, but this proved immensely helpful in getting organised. There was a broad skill mix, with general surgery, paediatric orthopaedic and spinal surgery expertise supplied by our US colleagues, supported by another two anaesthetists, a retired orthopaedic surgeon, and another junior doctor from Sunil Batra.
A draft of the following week’s operating lists was prepared, and for patients whose fractures appeared close to union, connecting bars from the external fixators were removed in anticipation of removal of the pins later in the week.
Where ever possible, complex cases were tackled at the start of the week to allow problems to be addressed before the team departed. Equipment for each case had to be selected from the extensive stores, then packed and sterilised. The necessity for this extra forethought helped assure that procedures were carefully planned to the last detail. Prior information about the possible plastic surgery workload was difficult to ascertain. However, the ability to perform ortho-plastic cases was essential, from skin-grafting necrotising fasciitis, spinal fusion and sacral pressure sore soft tissue coverage, to limb salvage with bone resection and shortening, fascio-cutaneous flap coverage and bone transport. In addition, the combined skills of general and plastic surgery meant that a locally very advanced breast cancer could be treated effectively to achieve local disease control.
Haiti’s problems continue and she will remain dependent upon international support for some time yet. For those who have not volunteered before, a leap of faith is required. If that leap means landing in an environment with a limited infrastructure, but above all organisation and determination, a great deal can be achieved.
Mr Saqib Noor, Trauma and Orthopaedic Trainee
Professor Ian Pallister, Trauma and Orthopaedic Consultant
For more information, visit: www.haitihospitalappeal.org and www.crudem.org