Abstract
Purpose
On January 12th, 2010 a magnitude 7.0 earthquake struck the downtown area of Port au Prince, the capital of the poorest country in the western world. Nearly a quarter of a million people were killed and a million other were injured. Our goal was to provide follow up and acute care to injured Haitain patients.
Method
During an eight day period in June of 2010 a group of three physicians from Memorial University were part of a humanitarian mission to this country in conjunction with the University of Maryland and the humanitarian group Catholic Relief Services (CRS). Attempting to provide orthopedic care six months after such a disaster presented numerous challenges in this part of the world. Security and travel were always a concern due to the rising number of foreign kidnappings that plague the capital city. The heat and humidity made the simplest of tasks exhausting and uncomfortable. Living conditions, although above average for Haiti, consisted of no heated water, diseased mosquitoes, and sleeping of concrete floors. CRS provided us with the means to deal with all of these challenges.
Results
Care was provided at Hospital St. Francis de Sales which was devastated during the earthquake. Two hundred bodies remained buried in the rubble and less than 20% of the original structure remained standing and functional. Wards consisted of donated military style tents with minimal protection from the elements. Communication with the short staffed nurses and abundant patients required the use of translators or a familiarity with French or Creole. Attaining x-rays required outside transport of patients and blood work was only done in an emergency situation. Surgical cases took place in a surgical theatre with two OR tables operating simultaneously. A nurse anesthetist provided care for all surgical patients with only one operational anesthetic machine. Lack of basic supplies on a day to day basis and frequent and ill timed power outages ensured even the smallest of cases presented their own challenges.
Greater than 25 orthopedic cases were completed during our mission. These were wide in scope including the complications of earthquake trauma, fresh trauma, hip fractures, and tumor removals. Five Moores hemiarthroplasties were performed as this was the only prosthesis available. ORIF of fracture nonunions included a midshaft humerus, a both bones forearm, several midshaft tibias, and an infected humeral supracondylar fracture. Cases were completed with incomplete equipment sets and without a scrub nurse.
Conclusion
Providing orthopedic care in less developed areas of the world present numerous challenges. Utilizing humanitarian organizations that are well organized and integrated into the culture are essential. Orthopedic surgeons must be willing to rely less on technology and more on basic principles and hard work to provide safe and beneficial care where it is truly needed.
