1/22: Progress report from OAM team in Haiti

We are here working with Partners in Health. We are stationed presently at the General Hospital in Haiti. Last night we arrived and immediately were thrown into the action as the night surgical team. Night surgery just started today.

We are operating. Several buildings of the hospital have been damaged by the earthquake and we are working in rooms which were not originally Operating Rooms. They were converted but we had no anesthesia machines and basically only sedation, IV’s, medications, and masks for treatment.

In that setting, it was limited staff and we were only doing emergency surgery at night. Our team performed three or four surgeries including exploration of a possible popliteal artery injury and external fixator placement, etc.

Organizationally, as one would expect things are challenging.  This particular site has become a way station for most of the downtown area. The hospital ship Comfort has arrived and is beginning orthopaedic cases which require either C-arm and  is really there because of the resources at this point in time.

Jim, myself and Matt have spent most of this morning triaging about only 20% of the patient population, almost all of which is housed  in a park-like setting and make shift huts as shelter.  This is because the original resident portion of the hospital has been damaged by earthquake.

Under and over triage is certainly a problem. Limited x-ray availability has made clinical exams a really important part of what we’re doing. We have been working with the Navy to assist in appropriate triage to the hospital shift. This apparently  has been a weakness of this center up to this point in time.  Especially since we are trying to avoid sending patients that we can care for here.

In addition, today Rob Dean and I have been working with the hospital director, the existing patient physicians, and orthopaedic residents.  We think this is especially important because of  all the teams (the Swiss and several other university teams) we are one of the few who intends a somewhat longer term presence here.

We have offered cooperation and in return they have been setting up two fully equipped OR’s for us including anesthesia machines today and we hope to start daytime tomorrow with that. We have multiple cases already slated most of which are debridements, revision amputations, and external fixator placements.

Hopefully the progress we made today might impact the future, but again, logistics are significant.  Last evening we actually quit performing any sort of nonemergent surgeries because there were no actual beds in which to place patients.

Some have asked about our living conditions: They are somewhat limited. We drive from the hospital through essentially destroyed Port-au-Prince downtown for almost 45 minutes to a school compound.  Of course there is no running water and we are sleeping in tents on concrete.

Be assured we are all well, healthy, and in good spirits. We truly appreciate the support of our colleagues and partners who have assisted us in being here and strongly encourage your continued support and prayers.  Certainly the need is real and ongoing.

David J. Bielema, M.D