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In This Issue:
From left, Jonathan Gates, MD, Joaquim Havens, MD, and Bill Peranteau, MD, operate in Haiti. Inset: Trish Powers, RN, and Gusmaie, a nurse at University Hospital in Haiti.
Clinicians last week packed the Bornstein Amphitheater for a special Orthopedics Grand Rounds and listened intently as some of the many BWH and Partners Orthopedic Trauma surgical staff who volunteered in Haiti detailed their experiences.
Trish Powers, RN, one of the nurses on the team, vividly remembers groups of local Haitian residents crowding around American clinicians as soon as they arrived in Port-au-Prince Jan. 20.
“They were speaking in Creole, but I knew they were asking for help,” said Powers, an orthopedic nurse in the Operating Room at BWH who described her experience participating in earthquake relief efforts as life-changing. “I felt afraid for the first time—not for my safety, but afraid that we wouldn’t be able to help all of these people.”
But the clinicians who volunteered did help—hundreds, in fact. Powers, who presented with Jonathan Gates, MD, Selwyn Rogers, MD, MPH, Malcolm Smith, MD, and George Dyer, MD, at rounds moderated by Mitchel Harris, MD, is among more than 50 BWHers who already have deployed to Haiti as part of an ongoing hospital response with Partners In Health.
Gates and Powers worked with a Partners In Health-organized team at University Hospital in the devastated city of Port-au-Prince. They described a somewhat chaotic situation, with two not yet functional operating rooms and an array of tents—some of which consisted of tarps draped from tree to tree—where patients received care and recovered.
Immediately, they began to assess available resources, map out the grounds, understand their capabilities and limitations and talk to everyone they could. They organized patient flow by creating triage, pre-op, OR and post-op areas, and they established four operating rooms with surgical supplies, a scrub sink, anesthesia supplies, instrument cleaning and an OR booking desk.
“I can’t underscore enough how much teamwork was required,” said Gates, medical director for Trauma. “People selflessly did what they needed to do to help in every way possible.”
Powers described the lack of equipment and surgical supplies, noting how pleased she was to have sterile pins, even though drills could not be sterilized. “I cannot tell you how much a simple thing we take for granted here every day meant to me,” she said.
In total, the team performed 117 surgeries, operating on as many as 30 patients a day once they had set up the ORs. “The patients and families were incredible; they tried to help in any way they could,” Gates said.
About 60 miles north of Port-au-Prince, another group was treating trauma patients in Saint Marc at a hospital unaffected by the earthquake but overwhelmed with patients in need of care.
“The first night we arrived, there were no beds in the wards and patients were lying on the floor in every direction on scraps of mattresses they brought with them,” said Dyer, an orthopedic surgeon. “Keep in mind, these are the patients who fared the best, escaping the rubble to travel 60 miles to the hospital.”
Immediately, the team spent hours walking from patient to patient, writing down names and information on a list. “We catalogued the injuries of 142 trauma patients, many of whom had injuries we categorize as emergencies here,” Dyer said, adding that these patients had sustained the injuries four days prior.
There was no computed tomography, portable x-ray or basic laboratories. “It was overwhelming to be faced with more than 200 patients with fractures, abdominal pain and other injuries without the resources we usually have,” said Rogers, chief of Trauma, Burn and Surgical Critical Care.
The team assembled two operating rooms and developed a triage system that enabled them to perform 216 earthquake-related procedures, including 136 surgeries and 80 complex dressing changes under anesthesia.
Initially, some patients saw that others were undergoing amputation and refused surgery themselves, knowing the alternative was death. “In Haiti, you lose your leg, you lose your life,” Dyer said, citing the lack of equipment and access, such as ramps, for amputees.
Smith, the chief of Orthopaedic Trauma at MGH, worked with the team in St. Marc and returned to Haiti with Project Hope two weeks ago, learning that already there are about 4,000 new primary amputees in the country. He said there has been a shift in patient needs, with so many now desperately needing ongoing rehabilitation and nursing care.
He recalled the story of Ania, a 15-year-old who needed an above-the-knee amputation. Though she and her father initially refused surgery, she eventually underwent the life-saving amputation and is doing well.
Smith suggested that people like Ania be given jobs, not only to help them earn a living but also “to show that disability isn’t a death sentence.”
Trish Powers, Selwyn Rogers, Malcolm Smith, George Dyer and Jonathan Gates present at Orthopedic Grand Rounds.
BWH’s Surgical Response to Haiti March 17
There is a panel discussion featuring clinicians who responded to Haiti on Wednesday, March 17, 8:15 - 9 a.m., in Bornstein Amphitheater. Panelists include moderator Selwyn O. Rogers, MD, MPH, and Mitchel Harris, MD, Ramon Martin, MD, George Dyer, MD, Patricia Powers, RN, William Peranteau, MD, Joaquim Havens, MD, Robert Riviello, MD, MPH, and Jonathan Gates, MD.