Guest blog by Dr. Greg Elder, Deputy Operations Manager, and Oliver Yun, Medical Editor, Médecins Sans Frontières/Doctors Without Borders, New York, NY
Médecins Sans Frontières/Doctors Without Borders (MSF) has been working in Haiti since 1991 and, until the devastating January 12 earthquake, had three medical structures running in the capital, Port-au-Prince: the 60-bed Trinité Trauma Center hospital for free surgical care, 75-bed Maternité Solidarité hospital for emergency obstetrics, and Martissant emergency health center in the Martissant slum.
With teams already present in Haiti, MSF was able to respond immediately to the earthquake. However, this response has thus far been quite limited due to two factors we have not often faced.
First, the quake greatly damaged all three of our facilities, including the collapse of Trinité hospital, effectively shutting them down. With all our hospitals no longer functioning, they were evacuated, and tents have been set up outside on the hospital grounds for patients. In addition to caring for current patients under these conditions, the huge influx of new patients to these makeshift tented sites has been overwhelming. We have treated about 2,000 patients at the time of this writing, mostly for wound care.
Second, those individuals who normally provide and coordinate emergency humanitarian aid, the first responders, are themselves victims of the quake. We are still in the process of accounting for all our 700+ Haitian colleagues who were on the ground at the time of the quake. With no structures to work or live in, our team on the ground are working around the clock in 12-hour shifts, and sleeping outside with the population.
Aside from the urgent relief needs of the people (food, shelter, water and sanitation), our main medical focus at this time is wound care and re-establishment of surgical capacity. The surgery needs for the quake victims are huge: open fractures, deep wounds, crush injuries, amputations. Timely surgical care is essential to avoid the development of serious infections. Thousands of people are waiting for surgery at the few hospitals still functional. We have sent more than 400 patients in need of surgery to Choscal Hospital in Cité Soleil district of Port-au-Prince, where an MSF team has begun working in the operating theater there.
At the time of this writing, we are trying to get an additional 70 staff and 40 tons of medical and aid supplies into the country. Access at this time however is highly difficult, with the damaged airport saturated with relief flights and bottlenecked in terms of entry of materials and human resources. A 100-bed inflatable hospital, with two operating theaters, intensive care unit, and emergency room, is en route to Haiti, along with additional medical staff including surgeons, anesthetists, and nurses. Nephrologists are on their way to deal with crush syndrome (traumatic rhabdomyolysis), which MSF also faced in the 2008 China and 2005 Pakistan earthquakes. Mental health staff are also being sent to provide psychosocial support for victims, as well as our colleagues.
Misplaced fear of disease spread from dead bodies is often invoked in the media, and sometimes even by health care professionals. Based on prior MSF experiences, mass infectious-disease epidemics after natural disasters are extremely rare. Still, diarrhea and respiratory tract infections in crowded resettlement areas with poor sanitation do pose a real risk.
The quake has led to the near-total collapse of an already weak health care infrastructure in and around Port-au-Prince. Tensions are running high among the displaced and injured population waiting for desperately needed relief supplies. Even after this urgent crisis phase ends, mid- and long-term health care needs for Haiti will need to be buffered for years to come.