Helping Haiti: U.S. doctors reflect on crisis care experiences
■ Working in harsh conditions, physician volunteers struggled to meet the country's overwhelming health needs after January's devastating earthquake.
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It was about 7 p.m. when the ground began to shake -- again.
Family physician Douglas McKeag, MD, saw panicked patients hobble on fresh casts and fractured bones, some dragging IV poles, as they rushed to flee the converted schoolhouse where he was working in a Dominican Republic city near the Haitian border.
Some patients on the second floor jumped from a balcony; one patient broke his back doing so. The building was still standing when the aftershock ended, but no one wanted to go back inside.
"We were out in the field taking care of patients, trying to restore order all night long by flashlight," Dr. McKeag said. "We continued to get aftershocks or other quakes, ones that were even longer than that first one. We were delivering care between earthquakes, outside in the middle of nowhere. It was surreal."
Dr. McKeag, from Indiana, was among scores of U.S. physicians who took leave from their everyday duties to respond to the aftermath of the 7.0-magnitude earthquake that struck Haiti Jan. 12, killing an estimated 230,000 people and injuring another 300,000.
Challenged by Third World circumstances exacerbated by disaster, and awestruck by the resiliency of Haitian patients and families, physician volunteers found both heartbreak and hope in Haiti.
Wall-to-wall news coverage of the deadly quake prompted many physicians to travel to Haiti. When they got there, most were taken aback by the enormity of the catastrophe and the never-ending stream of patients.
Samir Mehta, MD, and two other surgeons from Philadelphia did 75 surgeries in nine days at a remote village hospital run by the Boston-based medical aid group Partners in Health. There were 250 patients in the 125-bed facility, and the doctors' days started at 6:30 a.m. and ended about 10:30 p.m.
"The biggest issue was the sheer volume," said Dr. Mehta, chief of the orthopedic trauma and fracture service at the Hospital of the University of Pennsylvania.
Injuries that would have been treated within hours in the U.S. often took weeks to get treated in Haiti, and working conditions were subpar.
Dr. Mehta and his colleagues had only one x-ray machine and often would wait days to see postsurgical images.
"We had flies in the operating room," Dr. Mehta said. "You just have to change and adapt the kind of care you provide."
"Perpetual disaster" made worse
Steven Landau, MD, a family physician from Smithfield, N.C., had been to Haiti eight times before, yet he still was surprised at the gravity of the situation. Haiti is "in a state of perpetual disaster. It's just so much worse this time."
Like many other physicians, Dr. Landau flew into the Santo Domingo airport in the Dominican Republic and took a bumpy ride across the border to get to the Haitian capital.
One patient he cared for at the Ananda Marga Universal Relief Team's mobile clinic in Port-au-Prince arrived with a fractured arm encased in a cardboard box serving as a makeshift cast. This was apparently the only treatment the patient received during the two weeks before seeing Dr. Landau.
The doctor replaced the box with a fiberglass arm splint.
Dr. Landau's overall experience in Haiti was exhausting. It was difficult to leave when he knew so many patients remained in need. But he also felt a sense of accomplishment doing "something concrete for suffering humanity."
Dr. Landau does not know Creole, but he does speak Spanish and French, two of the other languages spoken in Haiti.
Dr. McKeag, the family doctor from Indiana, had to rely on translators -- often a chain of translators going from Creole to French to Spanish to English and back again.
"When we found someone who spoke both Creole and English, it was like gold," said Dr. McKeag, a sports medicine specialist and former chair of the Dept. of Family Medicine at the Indiana University School of Medicine.
An emotional toll
Many physicians said they struggled to rein in their emotions while dealing with the enormous medical demands in Haiti.
"It really was just about maintaining my sanity," said Daniel Ivankovich, MD. "We were putting in 20-hour days. The need was greater than what we could physically provide."
Dr. Ivankovich, a Chicago surgeon who specializes in spinal cord and orthopedic reconstructive surgery, traveled to Haiti Jan. 21 and worked at the Sacred Heart Hospital in Port-au-Prince. He managed to bring two patients back to Chicago for spinal cord surgeries that could not be performed in Haiti.
Jean B. Ford, MD, who was born in Haiti and moved to the U.S. when he was 16, remembers moments during his two-week relief mission when he had to step away to collect himself.
"I didn't want to cry in front of my patients," said Dr. Ford, an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health in Maryland. "It was just overwhelming. You've never seen anything like that." He provided internal medicine care, working with the University of Miami's Project Medishare for Haiti.
One girl Dr. Ford got to know was found pinned underneath rubble next to her parents' decomposing bodies. At the clinic, she was asked how she was doing. Her response: "I don't have a mommy or a daddy."
Amid the sadness, Dr. Ford was amazed at the resilience he witnessed. He hopes to return to use his skills as an epidemiologist and help with the rebuilding.
"There is this optimism you hear of people willing to rebuild their lives," he said. "It was an inspiration for me."
Dr. Mehta, who returned to Philadelphia Feb. 7, said he hopes to travel to Haiti in June or July to perform the more complicated reconstructive orthopedic surgeries that many patients need.
He recommended that doctors go to Haiti only as part of an organized effort. While some relief agencies are reporting a surplus of physician volunteers, the long-term health needs of the country are staggering.
"They may not need you right now, but eventually they will," Dr. Mehta said. "There will be a need for physicians in Haiti for a long, long time, and your time will come."