When a 7.3-magnitude earthquake struck Haiti on Jan. 12, leaving behind a death toll of more than 250,000, Sachita Shah, MD, of Providence, Rhode Island, was among the volunteers who packed her bags and headed to the Caribbean country to offer her services.
She volunteered with Partners in Health (Boston) and arrived in Haiti on Jan. 16. She spent most of her time treating patients at St. Marks Hospital (Port au Prince) where she quickly learned that many Haitians would prefer death to amputation.
“Our first couple of days at the hospital were shocking and difficult, and we found around 200 patients laying on the floors of the wards, 40 with urgent operations needed for open fractures and festering wounds and a dirty non-functional operating room,“ Shah wrote in a Facebook post from Haiti on Jan. 27, reflecting on her experience there as she prepared to return to the U.S.
The team developed what Shah termed the “fly criteria“ to help gauge which patient's wounds were most infected, she noted.
“Our patients were devastated, and dying of sepsis and their urine was turning black from rhabdomyolysis. Over the first two days we created order from this chaos, despite daily issues with security and mobs; lack of water, food, and supplies; missing doctors and nurses from the Haitian staff; and no communication with the outside world (no phone service, no Internet, no sat phone service). The OR was cleaned and stocked, a recovery area was created from a stock room, stretchers were cleaned and built, and patients were laid in mattresses, identified, examined, comforted,“ Shah wrote. “We started a triage system to save lives, then limbs, then fix fractures that were stable and clean non-life-threatening wounds, and do follow up care. We found patients with spinal injuries and pelvic fractures that we listed for evacuation and connected with the U.S. Navy to take several by helicopter from a nearby soccer field.“
But despite the group's best efforts, Shah says, every day there were “unanticipated obstacles and setbacks.“ A couple nights into the team's stay there was an earthquake aftershock that shook the house they stayed in. “We all ran outside, got to the hospital, and found the OR with damage and several newly injured patients who had jumped from their roofs and windows because they were afraid they would end up under a pile of rubble,“ Shah said.
Another unexpected challenge Shah and her fellow volunteer physicians encountered was the attitude that many Haitians have toward amputation. Because the condition and future for the physically handicapped in Haiti is severely limited, many of the patients Shah treated refused amputation despite the risk of death from infection, she said.
“I was surprised, but they told us 'amputation is like death in Haiti' over and over again, and looking around, you could see what they meant,“ Shah told Medical Device Daily in an email this week. She is now back in Haiti, again offering her services to patients in the devastated country. “The roads are uneven, there are no ramps or accessible schools/jobs etc. and amputees are often outcast. I think this will change now that there are thousands who all shared the same experience, but it will take time and rebuilding Port au Prince and all of Haiti to accommodate“ these people.
When asked how she and other volunteer physicians responded to these patients, Shah said the team spent a lot of time talking with them, counseling them, having them talk to other amputees, and “buying time by doing washout surgeries to keep their infections at bay.“
But the group also met resistance from the local hospital staff who seemed to think the volunteers were overly aggressive about amputations.
“Because we did 10 amputations on the first day, and patients returned to the ward hour after hour sans limb, it was a big shock for the staff and patients since this is normally a rare surgery,“ Shah told MDD. “We did meet resistance, because of the cultural stigma associated with amputees, and had to spend time in discussions and rounding and operating with local orthopedic surgeons to help change the perspective. We learned that their approach to this situation would be to give as much time as possible for the 'life to go out of the limb' and let it turn black before amputation, to allow time for the patient to accept the prognosis and treatment. We learned a lot from each other.“
In an effort to help improve life for amputees in Haiti, Shah said prosthetic companies have been generous in donating prosthetics, and physical therapists and rehabilitation doctors are working in Haiti already. Many of the patients Shah treated were transferred to another nearby hospital where they have already been fitted with prosthetics. But she added that the challenges these patients will face go well beyond the usual logistic and “getting around“ challenges.
“Our patients who have undergone amputation will face trouble with getting around to finish schooling and to get jobs. It will be a long hard road. The children who were amputated will need to be fit and re-fit frequently to get limbs that fit right based on their rapidly growing height and size,“ Shah said.
One example of the technology that Shah is using in Haiti is the MicroMaxx ultrasound tool, designed for point-of-care imaging. The system looks a lot like a laptop computer and weighs less than 7 pounds and providing a 10.4-inch image display. According to its maker, SonoSite (Bothell, Washington), one of the key benefits of the system is its quick boot up time – just 12 seconds.
But the company is quick to point out that although the system is a hand-carried unit, it offers “big machine performance,“ designed to yield high-quality images with speed and reliability while operating on either AC or battery power, SonoSite said. “The MicroMaxx system software is hard-wired and purpose-built for faster boot-up times, faster digital image processing, and the ability to run for a long time,“ the company notes.
Another problem Shah encountered during her first trip to Haiti after the quake was patients dyeing from pulmonary embolisms because they had not been getting out of bed, moving their limbs, and the volunteer staff had no Heparin to prevent patients from getting these clots. On the seventh day after the earthquake, Shah's team had five deaths within one hour, she wrote in her Facebook post.
By the time Shah prepared to leave Haiti after her initial visit – 12 days after arriving – the team at St. Marks had completed more than 120 operations and patients were beginning to get discharged to homes and shelters.
She told MDD that she wishes she had taken a couple days of down time after returning home after her first visit to Haiti rather than “jumping right back into work“ as she did. “It is a pretty troubling experience, to see and be near so much suffering, and become friends with so many who have endured such pain,“ Shah says. “It is hard to keep one's feelings separate from the work for the whole time, so in the end of my time there, I really felt the sadness and sorrow of my patients, who had become my friends.“
Amanda Pedersen, 229-471-4212;