January 26, 2010
Four years ago the initial medical response to Hurricane Katrina was ill equipped, understaffed, poorly coordinated and delayed. Criticism of the paltry federal efforts was immediate and fierce.
Unfortunately, the response to the latest international disaster in Haiti has been no better, compounding the catastrophe.
On Tuesday, Jan. 12, a major earthquake overwhelmed a country one hour south of Miami whose inhabitants include American citizens and their relatives. Thanks to the Internet, pictures of the death and destruction were familiar to the world within hours, and the need for a massive influx of relief and specialized medical care was instantaneously apparent. While particular fatalities such as head injuries or massive blood loss are rarely treatable in mass casualty situations, delayed deaths from infection may be preventable.
On Wednesday, the day after the quake, we organized a relief team in cooperation with the U.S. State Department and Partners in Health (a Boston-based humanitarian organization) to provide emergency orthopedic and surgical care. We wanted to reach the local hospitals in Haiti immediately—but were only allowed by the U.S. military controlling the local airport to land in Port-au-Prince Saturday night. We were among the first groups there.
This delay proved tragic. Upon our arrival at the Haiti Community Hospital we found scores of patients with pus dripping out of open fractures and crush injuries. Some wounds were already infested with maggots. Approximately one-third of the victims were children. Most of the patients already had life-threatening infections, and all were dehydrated. Many had been waiting in the hospital compound for days without water, antibiotics or even pain medicine. The hospital smelled of infected, rotting limbs.
Our team spent the next 60 plus hours performing a variety of operations including orthopedic repairs to broken limbs and amputations. Sadly, a limb amputation in an underdeveloped country may be a death sentence.
We tallied over 100 operations between four surgeons and three orthopedic fellows (medical doctors getting additional specialty training), and evaluated perhaps 100 more patients for surgery. In contrast, a busy night in a New York City hospital might include four or five surgeries. Hindering the effort was an absence of ventilators, anesthetic machines, and oxygen tanks. There was no blood bank or laboratory, and a dearth of surgical instruments. Due to the lack of resources, we know many patients may still succumb to infection and other postoperative complications.
The U.S. response to the earthquake should be considered an embarrassment. Our operation received virtually no support from any branch of the U.S. government, including the State Department. As we ran out of various supplies we had no means to acquire more. There was no way to transfer patients we were poorly equipped to manage (such as a critically ill newborn with respiratory distress) to a facility where they would get better care. We were heartbroken having to tell patients suffering incredible pain we could not perform their surgery for at least a day.
Even after hearing gunshots outside the hospital, we had no protection for ourselves or our belongings—though we observed that a Jamaican medical team came with armed guards.
All these problems stemmed from ours being an isolated operation, a feature that may work in a humanitarian medical mission but not in a disaster situation. Later, as we were leaving Haiti, we were appalled to see warehouse-size quantities of unused medicines, food and other supplies at the airport, surrounded by hundreds of U.S. and international soldiers standing around aimlessly.
With an organized central command dedicated to medical relief, we could have done much better. A reconnaissance team, managed by government or U.N. officials in conjunction with medical and logistic specialists, could have immediately come to Haiti to evaluate local facilities. Preapproved groups of experienced civilian and military medical teams could have been consolidated in the U.S. from the Pensacola, Fla., military base or other locations, to avoid the airplane traffic clutter and delays that plagued landing of people and supplies into Port-au-Prince. Targeted teams with military support could then go to adequate facilities where they could be most effective.
After the disaster, certain roads should have been secured to allow the transfer of patients or supplies. A base hospital could have been established for patients requiring specialized services (such as a neonatal ICU and neurosurgery). A specialized, postoperative care center should have been established. In our case, however, we lacked the resources to ensure that patients were receiving basic wound care, antibiotics, nutrition or hydration.
The death toll from Katrina was under 2,000 people. Deaths in Haiti as of yesterday are at least 150,000. Untold numbers are dying of untreated, preventable infections. For all the outcry about Katrina, our nation has fared no better in this latest disaster.
Dr. Eachempati is a trauma surgeon and incoming president of the New York State Chapter of the American College of Surgeons. Drs. Lorich and Helfet are orthopedic surgeons. All practice at the Weill Cornell Medical Center in New York City.