Marshall providers tackle Haiti devastation.
Article Type: Report
Subject: Earthquakes (Haiti)
Earthquakes (Casualties)
Health care teams (Services)
Health care teams (Powers and duties)
Missions, Medical (Management)
Pub Date: 03/01/2010
Publication: Name: West Virginia Medical Journal Publisher: West Virginia State Medical Association Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 West Virginia State Medical Association ISSN: 0043-3284
Issue: Date: March-April, 2010 Source Volume: 106 Source Issue: 2
Topic: Event Name: Haiti Earthquake, 2010 Event Code: 360 Services information; 200 Management dynamics Computer Subject: Company business management
Geographic: Geographic Scope: Haiti Geographic Code: 5HAIT Haiti
Accession Number: 223908178

STAT blood transfusions took 48 hours ... a bicycle pump became surgical equipment ... eyes and hands replaced nonexistent x-rays ... and pro baseball players pinch-hit as transport orderlies.

Marshall's faculty, staff and medical student who traveled to earthquake-devastated Haiti in January in connection with church aid groups found the resilient people inspiring, their needs beyond imagination, and improvisation and teamwork core components of delivering care.

Chairs of family medicine, internal medicine and orthopedic surgery were among several Marshall faculty members providing aid.

"We all had a personal moral feeling that we needed to step up," Dr. Kevin Yingling told the Charleston Daily Mail. He and several others already are planning return trips.

Five days after the Jan. 12 earthquake, fourth-year medical student Stephen Shaffer had rearranged his schedule to add a four-week international health elective there, and he and Dr. John Walden were on their way to Good Samaritan Hospital on the border of Haiti and the Dominican Republic. Walden primarily performed triage, while Shaffer teamed up with a generalist physician to change dressings, set bones and cast fractures.

"All of us have something to learn about responding to a disaster with total devastation and the ensuing chaos," Walden said, adding that the military comes the closest to providing the structure and services needed in that situation.

He was impressed during his week there by the ability of people from all over the world and from all walks of life--from military personnel to physicians and even professional baseball players--to coalesce into teams and deliver services under adverse conditions.

"Everyone pretty darn quickly adapted to the fact that there was little to do with, but they managed to do it," he said.

Back in Huntington, Dr. Ali Oliashirazi was working with Gov. Joe Manchin to get a team of 22 Huntington physicians and other providers, together with some 3,000 pounds of equipment and supplies, to a hospital near Port-au-Prince that needed a medical team the last week of January. The team had four surgeons available to keep the hospital's two operating rooms open around the clock for the week they were there.

"You would think they planned it for a month, but it came together in about 24 hours," Gov. Manchin said. He arranged for them to travel to Port-au-Prince on a jet funded by Pittsburgh philanthropist Jim Bouchard, Esmark and Highmark Blue Cross Blue Shield. Despite the needed U.S. government approvals--complicated by the fact the group was taking the largest legal narcotic shipment ever made to Haiti--the team of physicians and support staff was airborne Jan. 24.



Although the team had an important edge because it included both equipment and the support staff necessary back up the physicians, Dr. Oliashirazi said some barriers were great.

"From a medical standpoint, our biggest challenges included lack of basic equipment, including crutches, lack of a full spectrum of antibiotics, lack of adequate laboratory support (we could ONLY obtain a CBC), inability to obtain any microbiology or cultures, and unavailability of x-ray in any form," he said. "We were diagnosing fractures by palpating the limbs and reducing fractures based on whether the limb looked 'right' or not. We had two patients with a hemoglobin of 4 and 6; our STAT blood transfusion order took 48 hours to get to our hospital."


With hundreds of Haitians seeking care the first day, a critical need was to create a basic structure and patient charts.

Seeing patients who had been treated elsewhere and had no medical records was particularly difficult, Dr. Oliashirazi said. Patients with long arm casts, for example, often had no idea where the fractures were, whether there were wounds that needed to be evaluated, or how long the cast was to remain.

"The dilemma was, do we take the entire cast off and re-evaluate for fracture and wounds in a setting where we did not have adequate cast material, or leave things be," he said. "Probably half the time, we did take everything off to reevaluate. To help with these issues, we wrote the date of injury, type of fracture, any wound issues, tentative treatment plan both ON THE CAST and on a prescription given to the patient, in case they did not return back to our facility. We, of course, also made charts for the patients at our hospital."

In retrospect, Dr. Walden remembers from the earliest days the toughness of patients who out of necessity underwent major surgical procedures without the "luxury" of general anesthesia and painkillers, which simply weren't available; he sees overwhelming future needs for rehabilitation, for meeting the needs of amputees, and for restoring infrastructure as basic as safe water. Dr. Oliashirazi recalls the myriad infections from wounds washed with well water, and Haitians who insisted on sharing with others despite their own privations. Stephen Shaffer remembers panic-stricken patients jumping out of second-floor hospital windows during an aftershock, and the difference made by the spirit and courage of one young boy whose broken femur was being treated using an external fixator (x-fix).

"Many of the patients we have left have x-fixes," the medical student wrote that night. "One important part of their recovery (and avoiding other complications) is physical therapy and basically getting them to walk. It is painful. It is scary. No one would do it. That is, until Malechi decided he was going to walk. He opened his own walker, staggered to his feet, and began walking up and down the front of the orphanage showing people they didn't have to be afraid. Most of us cried.

"Most of our patients are walking now. One brave little boy made an incredible difference."
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