Thursday, Jan. 21, 2010

Haiti's Medical Crisis: Treating Crushed Survivors

Jean Marc Loremas, 46, carried his niece more than a mile from their home in the La Plaine area of Port-au-Prince to a sparsely populated industrial zone. There he nodded to two foreign guards in olive green fatigues and about a dozen semiambulatory earthquake victims who were already lined up on various pallets, crutches and canes before pounding on a metal sliding gate. "Shalom?" came the response as the eyehole shot back. Loremas explained his needs, and soon an Israeli doctor came out to examine the woman's broken femur.

Eight hours later, they were still there waiting for treatment, but Loremas knew that his 18-year-old niece Richline was one of the lucky ones. Like his little sister, whom he had deposited at the same field hospital the day before, she would be getting the best care possible in earthquake-ravaged Haiti. The Israeli hospital can treat only about 100 people a day, but it is the paramount medical center operating in Haiti in the aftermath of the Jan. 12 earthquake. It receives the cases that other hospitals find difficult and cannot manage. Upon entry, patients are photographed, and then they and their electronic records are digitally tracked around the tent complex with bar-coded bracelets. Ninety percent of those in Israeli hands have complex crushed limbs and bones — crush syndrome. But given the severity of the injuries and the conditions in apocalyptic Port-au-Prince, the hospital has had an amazing success rate: of the more than 400 people treated by Jan. 19, only eight had died.

Would that all of Haiti were so lucky. As efforts turn from rescue to recovery, the crisis' biggest focus is medical care: tens of thousands of people are still in need of attention, and broken bones are quickly becoming deadly as gangrene sets in. "We have 300 to 400 patients waiting to be seen, and if we can't get to them in the next 48 hours, half could die," says Eli Call, an American volunteer at the Adventist University Hospital, which has more than tripled its pre-earthquake capacity, treating more than 1,250 people since the disaster. Most of Haiti's hospitals were destroyed in the earthquake. To fill the void, the U.N. has so far brought in seven field hospitals, including the Israeli one, to augment the few Haitian facilities that are left standing. On Jan. 20, the U.S.N.S. Comfort arrived, though a strong aftershock that morning took out the pier where it was hoped it would dock.

Aside from the basic triage — the treatment of relatively simple ailments that might have become life-threatening if left unattended over the nine days since the quake — the biggest problem is dialysis. A symptom of crush syndrome is kidney failure. Both the Comfort and the Israeli hospital are converted war units where dialysis is not generally needed. Local hospitals are no longer equipped for it, and the few willing to try it — like Doctors Without Borders — have had logistical nightmares getting the proper equipment in. Almost any patient pulled from the rubble with severely crushed limbs who doesn't get treatment or an amputation quickly enough runs a high risk of dying of renal failure. An 8-year-old boy pulled miraculously from the rubble on Jan. 20 after being buried for eight days will surely be watched for any indication of the syndrome.

"We scrounged for some equipment from the destroyed hospitals, and we have two patients on ad hoc dialysis, but they won't last long like this," says François Domet, a spokesman for Doctors Without Borders. The group reopened its facility at St. Catherine's Hospital in Cité Soleil, one of Haiti's most dangerous neighborhoods, after three of its offices around Port-au-Prince were destroyed. It has since opened seven more sites and has treated more than 3,500 patients in Cité Soleil alone. "Five patients died of kidney complications yesterday while several of our planes bearing dialysis equipment were told they could not land in Port-au-Prince," Domet says. The U.S. military, which controls the airport, says there is a big backlog of flights coming in, and it is doing its best to accommodate everyone.

Aside from crush syndrome and gangrene, patients with chronic health problems are particularly vulnerable. More than 200,000 Haitians have HIV/AIDS, and without medications they could fall seriously ill. Yvens St. Ylaire, who will turn 1 on Jan. 24, was born with a sealed anus. His parents have been saving up for an operation to fix the problem, and while they were waiting for the procedure, a shunt was inserted. He, his parents and twin sister survived the earthquake, but his shunt has not been changed since. His parents waited anxiously on Jan. 19 at the Adventist University Hospital for a doctor to help Yvens. "Our house was destroyed, and we lost three family members," says Erick St. Ylaire, Yven's dad. "But right now he is our first priority," he says, soothing his son's bloated stomach.

Every facility is overwhelmed, though the arrival of the Comfort and an additional 11 medical units should help. The Comfort, with its 550 medical staff members, can treat 1,000 people at a time, but getting to the ship has been complicated by the lack of piers. On Jan. 20, patients were either choppered in or taken aboard via amphibious boats. Medical teams are only now starting to move into neighborhoods to look for the ill who cannot travel — a process that will take weeks, if not months. "Getting a doctor is very, very difficult," says Loremas, hovering over his niece outside the Israeli hospital. "I pray to God every day to let me and mine live." There are few in Haiti who aren't saying similarly desperate prayers as doctors race against time to save as many as they can.

Read more in the new book TIME Earthquake Haiti: Tragedy and Hope and support TIME Haitian relief efforts