I received an email being forwarded around sent by a doctor who just returned from an emergency mission to Haiti. It tells of not just the natural catastrophe there, but the manmade chaos reigning in the aftermath. Of course this huge disaster means things are out of control, but some of the failures of the people and organizations now "in charge" are really unacceptable. And familiar, from the aftermath of Katrina. Even though many of us hoped that we'd come a long way past that kind of failure. Read the letter...
Subject: re: mission to haiti
Hello all,
Dr. Benevenia asked me to send out this letter that was forwarded to me. Something for us all to think about as we hear about conditions down there. Dr. Lorich is one of the trauma attendings at HSS.
I believe we went in with a reasonably comprehensive service we wanted to
provide acute trauma care in an orthopedic disaster. Our plan was to be at a
hospital where we could utilize our abilities as trauma surgeons treat the
acute injuries involved in an orthopaedic disaster. We expected many
amputations however came with a philosophy that would reasonably start limb
salvage in what we thought was a salvageable limb.
David Helfet put a team together which included:
2 orthopaedic trauma surgeons
3 orthopaedic trauma fellows
2 highly skilled anesthiologists
1 general surgery trauma surgeon
2 synthes reps who were also scrub techs
1 trauma nurse practioner to do triage
2 OR nurses
Our equipment including a huge amount of anesth medications and equipment,
ability to construct 150 ex fix both small and large, OR equipment including
scalpels etc, OR soft goods, splint material, OR prep material.
We also had a plan of physician and equipment replacemnt that was dynamic
where w/i 24hrs we could bring in what was necessary on the Synthes private
jet.
We thought the plan was a good one.
We were incredibly naïve.
Disaster management on the ground was nonexistent. The difficulties in
getting in despite the intelligence we had from people on the ground and
david helfet's high political connections with Partner's in Health as well
as the Clintons only portended the difficulties we would have once we
arrived.
We started out friday morning, got a slot to get in friday that was
eventually cancelled when we were on the runway to be rescheduled the next
day. We diverted to the DR and planned on arriving in P OP saturday.
Once on the ground the hospital we had intelligence that was up and
running with 2 OR's General Hospital was included severely in the earthquake
and not capable of running functioning OR's as there was no running water
and only a limited electrical supply on generator.
We quickly took our second option
Community Hospital of Haiti. We found approx 750 pt in the hospital upon
our initial eval, the hospital had running water, electricity and 2
functional OR's
Our naivette did not expect that the 2 anesth machines would not work,
there would be 1 cautery for the hospital, autoclave that fit instruments
the size of a cigar box, no sterile saline, no functioning fluoro and no
local staff only a ragtag group of voluntary health providers who like us
had made it there on there own.
To summarize we had no clue the medical infrastructure of the country was
so poor.
As we got up and running in the OR and organized the patients for surgery
we communicated our new needs back to Synthes and more supplies were loaded
for a second trip - these included battery operated pulse lavage, a huge
supply of saline, soft goods in the OR. This plane landed as planned sunday
pm, equipment was loaded on a truck and subsequent hijacked between the
airport and the hospital.
At the hospital we had zero security despite promises form NYPD and NYFD
to provide that to us.
Our philosophy was to work like this was a marathon run the OR's around
the clock with the idea that we would have a defined extraction time of 11pm
tues. The plane that extracted us would come in with a new medical staff
compliment to replace us. Equipment included urgent things to maximize
issues that were nonexistent in the hospital that would enable us to provide
better and more efficient care:
2 portable anesth machines
2electrocautery
2 portable monitors for the pacu
2autoclaves
Replacement exfix
Things that didn't arive with the previous flight
That planes slot was cancelled by the military at 6am tues.
We also previously had seen daylight in the remaining patients monday
night haviving completed approx 100 surgeries. However on tues morning we
found a huge # of new patients. The hospital was forced to undergo lockdown
closing its gates to the outside and outside crowd becoming angry.
We also noted tues morning that many of the patients we were operating on
were becoming septic.
We finished operating at noon tues, the last surgery our group assisting
an obstetrician on a caesarian and resuscitating a baby that was not
breathing.
We decided as a group the situation for us at the hospital was untenable
supplies were running out, team was exhauted, safety a huge concern, and no
extraction plan with resupply. We decided to make our way to airport thru
the help of a hospital benefactor. Jamaican soldiers with M-16 were
necessary to escort us out with our luggage as the crowd outside saw us
abandoning the hospital.
We made it to airport on back of a pickup track, got onto the tarmac,
hailed a commercial plane that carried cargo to montreal and had private jet
pick us up there.
The issues we were unprepared for and witnessed were
- The amount of human devastation
- The complete lack of a medical infrastructure in the country
- The lack of support of the haitian medical community
- The complete lack of any organization on the ground. Noone was in
charge, we had the first functional up and running hospital in the P OP area
yet noone and I me NOONE came to the hospital to assess what we were doing,
what we were capable of doing and what we would need, to be more efficient.
The fact that the military could not or would not protect the resupply
equipment on sunday or let the tues flight come in says it all.
- Lack of any security at all at the hospital
I would take away that disasters like this need organization on a much
higher level than we had with the clear involvement and approval of the
military from the beginning.
Currently there is Noone obviously running the show and care is in chaotic
at best. MD's are coming in country with no plan of what the are going to
do. Surgeons that expect to just show up and operate are delusional as to
what there role would be as without a complement of support staff and
supplies they would be of limited or no value.
I hope this helps. We all felt as though we abandoned these patients and
that country and feel terrible. Our role now being back in NY is to expose
the inadequacies of the system to the media in the hopes of effecting a
change in this system immediatly. We feel that the only way to really help
now is an urgent programtic change and organization in the support of the
medical staff on the ground and what is critically needed to expeditiosly
bring in.
Cherrios on the tarmac are not getting it done on these patients which
clearly would be savable if good care could urgently be provided.
Please share this email with everyone and anyone you find might help.
Good luck
Dean
Dean G. Lorich, M.D.
Associate Director
Orthopaedic Trauma Service
I find appalling the failure of the military to run air traffic control reliably enough for top medical teams with plans filed in advance to get in and out. I find appalling the failure of the NYPD and NYFD to honor promises of security for those teams.
We are going to have more and more disasters like this one. We have to improve how we handle them, get good at it. Indeed, since our military and police approaches to disasters don't help, and elsewhere serve to cause vastly more harm than good, we should overhaul our emergency responses completely. Disaster response should include mainly non-military forces, with some military and police as necessary to restore and maintain order and security. Instead of pretending that our military is anything but a tool to inflict violence, we should scale back our military's budgets, personnel and roles in these disasters. In favor of types of services that actually help cope with the disaster.