A doctor's mission to Haiti

Are injured and struggling patients in Haiti more important than ill and injured patients at home? I thought about that as I sent out e-mails asking my already over-worked colleagues to cover my shifts, freeing me to deploy with Relief International.

It was still on my mind as I boarded a red-eye flight after the devastating 7.1 earthquake demolished so much of Port-au-Prince, leaving hundreds of thousands dead and many more than that displaced and homeless.

I flew to New York and then to Santo Domingo, and a helicopter ride later, I was in Port-au-Prince joining up with physicians, nurses, and other health care providers as well as the logistics people making up our team.

I considered myself prepared mentally for what I might find in Haiti, having seen and heard about many details in the press. In fact what I found on the ground one week after the quake was perhaps a little "less awful" then what I expected. The devastation was extensive and the scene chaotic, but the bodies had mostly been cleared from the street and I never felt a threat of violence. I quickly learned that while the Haitians on the whole seemed very demonstrative, their shouting, honking and gesticulating would quickly turn to a nod, a wave, and maybe a handshake.

Within 24 hours of my arrival we set up a tent clinic on a small field in a neighborhood in the hills of Carefour, just outside Port-au-Prince. Carefour was actually the epicenter for the quake, and determining where one town ends and the other begins is like finding the transition between Santa Rosa and Rohnert Park - mostly a line on the map. Still, we weren't quite sure what to expect, and our thoughts were that we would set up for a day or two and determine if there was a need, then go forward from there.

What we found was that within minutes, patients literally came pouring out of the hills. Carried on mattresses by neighbors and family, hobbling on makeshift crutches and wrapped in makeshift bandages, they came with broken bones, wounds, lacerations, burns, and other trauma - most of which had been untreated, or at best minimally treated.

One man carried in had an obviously fractured femur, his leg twisted to the side. We weren't set up to do surgery or hospital care, so we loaded him into a car and set off for a Medcine Sans Frontier clinic where we understood they were doing orthopedic surgery.

Shortly thereafter a women arrived with a similar injury. I rode with her to the clinic. Haitian roads are in terrible disrepair, and every bump, pothole, and ditch along the roughly 20 minute drive sent her howling as we didn't have any powerful pain medications at this point.

Later, after we had closed down for the day, a mother came running up carrying an infant in her arms. The baby had been struck in the head during the quake by a falling object and now she had significant swelling on the right side of her head, a gaze deviation, and paralysis on her left side. These were not promising signs and we scooped her into a car and down to the Marine Base where a helicopter was available to fly her to the USN Comfort.

The first few days were spent in large part determining the lay of the land. It turned out the MSF clinic was not doing orthopedic surgery, but rather would do some procedures, though not surgery. They were merely placing patients like mine in splints and casts which we were capable of doing.

While we started off with very minimal supplies (what we had been able to carry in a few duffle bags), supplies started trickling in from Unicef, the UN and other aid organizations. That gave us broader capabilities, including narcotic pain medications and procedural medications like ketamine. The dramatic injuries lessened, but we were seeing hundreds of wounds with various stages of infection and requiring significant care before they became limb threatening.

By the end, I did 11 straight days of patient care, seeing up to 75 patients a day. Most days were 14-16 hours between direct care and preparation and planning. The daily heat and humidity were oppressive. Sleep was hard to come by and I contracted scabies.

Exhausted on the travel home, I thought again about my original question. I concluded that no, the Haitian patients were no more important than my Santa Rosa patients, but the acute need was greater. I had been willing and able to go thanks to the support of my family and colleagues, and I was extremely grateful for the opportunity.