Mountains of foreign aid sits at the Port au Prince airport melting in hot sun. Meanwhile, Team Rubicon is en route to set up another field hospital at The Little Sisters of the Sacred Heart of Jesus at Delmas 18 Former Army SF Medic Mark Hayward of Team Rubicon provides this update: 100118 Haiti I have seen more truly grotesque and horrible injuries in the last 24 hours than I have seen previously in my entire medical career. Using information from the Jesuit Refugee Service, our team loaded the available medical supplies onto two small pickup trucks and rolled from the Novitiate to the southern part of the city. We had been informed that there was a refugee/displaced person camp with about 900 people including a number of injured. We drove through the city, again seeing a generally orderly populace, with PNH managing the lines and traffic jams at locations like a tanker truck distributing free fresh water from the Dominican Republic, and gas stations with long lines despite very high prices. We got to the displacement area (N18d31.529’ by W72d19.167’ if anyone wants to find it on Google Earth), which was simply a small park in a hillside neighborhood where most of the houses had collapsed or were badly damaged by the quake. It was very crowded but again orderly. No one mobbed us, no one yelled or fought. The locals were happy to see us, took us to a shaded area that had been cleared of tents (there are an incredible number of WalMart red Ozark Trail tents being used by displaced families; a brilliant use of scarce relief funds and my hat is off to whoever provided them). The locals brought a dozen chairs, there were neighborhood people who had volunteered to act as medical translators, we broke out our equipment and organized a little supply area/treatment area/micropharmacy, and started seeing patients. The first patient I saw was a young man of 18 years. I asked him his name, joked with him as I unwrapped the slightly stained gauze bandage covering his right hand. He held his hand cocked oddly at the wrist and the dressing was bulky and strangely lumpy. I kept soaking and peeling layers and I couldn’t understand why I wasn’t getting to his hand. The bandages were gray-green and had an odd smell. Since I’m not a complete idiot, I eventually realized that he was missing his two middle fingers. However, when I peeled off the last layer of bandages, I was appalled to see that he had sustained a traumatic amputation which had progressed to gangrene in the six DAYS that he had waited for basic medical care. I cleaned him up as best I could, dressed his wounds, started him on antibiotics that MIGHT arrest the infection in time for him to lose only his hand and wrist but save his forearm. I asked him his name three times because I didn’t want to forget it, so that I could pray for him and commend him to you for your prayers. I DID find out that he was left-handed (thank God!), and I sat him down in a shady area while Dave and Jim got on the phone and starting using all their connections to find a hospital where he could be taken so that someone could cut off his right hand. I was a little rattled, but I like to think I maintained a good professional demeanor. And I got back in line and started unwrapping the next patient. I will not describe in much detail the rest of the day. I can only assume that it was like Christmas in hell. The number of rotting, crushed, deformed limbs I unwrapped was ridiculous. If any statisticians are reading this, our team has estimated that we saw roughly 200 or more patients today. About 100 had simple fractures, about 100 had wounds ranging from merely severe and painful, to grossly infected and frankly gangrenous. We set aside five patients for special treatment, meaning that their injuries were so severe that they required either amputation (hands) or orthopedic surgery (fractured femur, fractured pelvis). Our technique for wound care was simple. First, soak off the bandages (if there were any). Second, wash/debride the wound with chlorhexidine gluconate (purple and viscous, like warm grape jelly). Third, remove any foreign debris. As an aside, foreign debris in this case means chunks of cement. Everything in Haiti is built of cement and I don’t recall seeing more than a handful of wounds that lacked the obligatory cement fragments, from the size of large sand grains to small peas. Fourth, cover the wound liberally with silver sulfadiazene cream (“the paste”). Fifth, dress the wound with sterile gauze and clean gauze wraps (Again, God bless Saint Mary’s hospital!). Sixth, educate the patient on wound care and oral antibiotic therapy. Repeat. and repeat. and repeat. For variety, mix this with crushed and broken limbs. Lots of lower leg/ankle and forearm fractures. Ortho-glass? Too bad; we didn’t have any. Instead, we used sticks and cardboard boxes. Jeff and Craig, our firefighters, were our designated splint team. A doctor or PA would identify a fracture (clinically -- no Xrays), describe its presumed location, and the fire guys would build a splint. Every one was a snowflake -- no two alike and each one a work of art. We’d send the patient off to find a stick so they could be non-weight-bearing for six weeks -- without crutches. Or sling, or swath, or just build something that looked like it might work, and pray. (Did that a lot, actually.) Tired of that? Figure out the best antibiotic for the patient based on the wound. How rotten is it? Oral antibiotics only, please. If it’s just sick and oozing pale green mucus, they get Augmentin. If it’s only festering, just silvadene cream, because we’re running out of antibiotics already. If it’s in between, guess and pray. Five days’ therapy to conserve supplies. The...
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Jan 19 2010, 12:49 AM
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