By Maureen Leahy
Earthquake shapes orthopaedic residents’ hopes for the future
The threat of personal trauma tests character. The way these Haitian orthopaedic residents concentrated on patient care rather than their own safety was exemplary.
Lewis G. Zirkle Jr, MD
Prior to the January 2010 earthquake, the 700-bed Hôpital de l’Université d’Etat d’Haiti (HUEH) in Port au Prince was Haiti’s largest hospital, treating more than 169,000 patients each year. It was also the only public teaching hospital in the country and the headquarters for Haiti’s national orthopaedic training program.
In the immediate aftermath of the disaster, HUEH’s orthopaedic residents selflessly cared for thousands of their traumatically injured countrymen. They did so in extremely dire surroundings with meager equipment and supplies, and with very little concern for their own health and safety. Until recently, many of them have been reluctant to recount their emotional experiences. These are their stories.
In the late afternoon of Jan. 12, 2010, Gilbert Gourdet, MD, was resting in HUEH’s resident’s quarters after working a 24-hour shift in the hospital’s emergency department.
“I was nearly asleep when I heard a strange noise—almost like furniture being moved—and then everything started to shake. When we realized it was an earthquake, my colleague and I immediately ran outside,” said Dr. Gourdet.
Outdoors, they couldn’t believe what they saw. “Electricity poles were swaying violently, much of the hospital was badly damaged, and the nursing school was completely destroyed,” he said.
Jacky Jean, MD, a 2nd year resident who had been on call that afternoon, remembered that the hospital’s courtyard was flooded with patients within 20 minutes of the quake. Covered in white dust and terrified, they looked like zombies. Many of them had sustained serious orthopaedic injuries. “Parents were running with injured children in their arms; others rushed in with people who had lost a leg or an arm—everyone was screaming for help.”
Amid the chaos and aftershocks, Drs. Jean and Gourdet and a small group of medical personnel treated the patients as best they could, using whatever they could find to make dressings, splints, and slings. They worked tirelessly, unaware of the fate of many of their colleagues. They learned later that all 200 nurses and faculty who had been inside the nursing college had perished.
“We triaged patients and treated injuries nonstop for the first 48 hours. We didn’t have nearly enough supplies, we had to use sticks to immobilize broken extremities,” said Mukkuaka Oda, MD, who was a 3rd-year resident at the time. Dr. Oda, who had been visiting friends outside the city, had returned on foot as quickly as he could to HUEH. “The roads were clogged with rubble, dead bodies, and the injured trying desperately to get to the hospital.”
Getho Chertoute, MD, was at home when the quake hit. He also returned to HUEH and within 2 hours was tending to patients in the courtyard. The situation was terrible, he recalled. They had no mass casualty system for treating the scores of victims and no lights or electricity. When daylight faded, they worked under the illumination of car headlights.
The next day, additional local medical help arrived at HUEH, but so too did an overwhelming number of new patients. Because the hospital’s buildings were so badly damaged, the doctors continued to treat patients outdoors. Many of the injured had bled to death overnight. The survivors languished in the heat on makeshift beds, waiting for care that, for some of them, was still days away.
“We cleared the dead and started a few primary care units with what supplies we could find,” said Dr. Oda. “We operated on patients in the open, using bed sheets for curtains.”
“Each of us was a one-man surgical team—we had to sedate our patients, perform the surgeries in open air, and get the dressings we needed. When the sun set and the light of the day was gone, we had to stop,” Dr. Chertoute said. “We worked like that for 4 days.”
Dr. Jean added, “It looked as though all was lost—the hospital was destroyed and the orthopaedic training residence was no longer habitable, but we continued every day to help the patients.”
By day four, the stench of decaying corpses overwhelmed the city, forcing many Haitians to stay inside their damaged homes. Those who went out did so in hopes of finding medical care for loved ones.
“As I traveled from my own home to the hospital each day, I treated complete strangers in their homes, providing primary care as best I could—dressing wounds, reducing dislocations, and in some cases, immobilizing limbs with magazines,” said Dr. Oda.
By this time, international medical help and much needed supplies had begun to trickle in to HUEH. The hospital’s recently constructed urology ward had been turned into a makeshift surgical ward with four beds, but there were no drapes, very little anesthesia, and only general surgery instruments.
“We performed amputations under local anesthesia until our supplies ran out. After that, we were forced to amputate using simple sedation,” said Kenslor Ralph Donald Hyacinthe, MD.
Mending a broken system
Even before the earthquake, HUEH was understaffed and poorly equipped. As a public hospital, it served the country’s most indigent citizens. Eighteen months after the quake, conditions at HUEH are only slightly improved. Two operating rooms with two beds each service the surgical needs of the entire hospital. Equipment such as anesthesia machines, surgical lamps, and surgical tables is either defective or obsolete. The shortage of orthopaedic surgical equipment is especially pronounced.
“HUEH still lacks the equipment necessary to provide quality medical care, including orthopaedic care, to a poor population who has neither health insurance nor the ability to pay for medical costs,” said Dr. Hyacinthe. “For example, we don’t have a pelvic set, a total hip arthroplasty set, a dynamic hip screw set, conventional plates, dynamic compression plates, cancellous and cortical screws, or power drill batteries.”
“We deal with shortages of medical equipment and medication throughout the hospital on a daily basis. Some days we can’t operate because we have no sterile gowns or drapes,” added Stanley Alabre, MD. “The electricity frequently goes out and we are forced to continue surgery using only head lamps or cell phones as lights.”
Despite the emotional toll of the earthquake and the current conditions under which they practice, the residents remain remarkably optimistic.
“When the quake hit, I was still a medical student studying for my exams—I wasn’t an orthopaedic resident yet,” said Dr. Alabre who spent 14 hours buried beneath the rubble of his home before being rescued. “After witnessing how unprepared Haiti was for handling the enormity of the disaster, I vowed I would help my people by becoming an orthopaedic surgeon.”
“We will always be grateful to the nongovernmental organizations (NGOs), including the Surgical Implant Generation Network (SIGN), that came to our aid during the catastrophe,” added Augustin Willer, MD. “These friends helped us develop ourselves as surgeons; as a result, we are better prepared to handle future disasters.”
Still a long way to go
In September 2010, at the invitation of Lewis G. Zirkle Jr, MD, 11 orthopaedic residents from HUEH attended the SIGN conference in Richland, Wash. During the conference, they learned how to treat difficult fractures with the SIGN nail. They also learned orthopaedic techniques such as the Ponseti method for nonsurgical correction of clubfoot, soft-tissue care, and flap coverage.
Extremely grateful for the experience, the residents are eager for more educational opportunities, including fellowships and standardized training. They also desire access to materials, technologies, databases, and research, as well as hands-on experience.
“The training component of our residency program is failing us,” said Dr. Willer.
“We need learning programs that focus on spine surgery, hand surgery, hip surgery, and arthroscopy,” added Dr. Hyacinthe.
Dr. Alabre advocates establishing educational partnerships with foreign medical providers. “We need teachers,” he stressed.
Above all, the orthopaedic residents at HUEH are passionate about providing their fellow Haitians with optimal care now and into the future.
“I plan to become a professor in HUEH’s orthopaedic training program,” said Dr. Oda. “I want to improve the exchange of information between our facility and other training programs around the world.”
“We want HUEH to become one of the best hospitals in the country where Haitians have access to the best care possible and the medical residents receive standardized and up-to-date training,” said Dr. Jean.
You can help
Partners in Health and other NGOs are establishing residency training rotations for HUEH orthopaedic residents in hospitals outside of Port-au-Prince that were less damaged by the earthquake. As part of its commitment to helping Haiti rebuild and strengthen its orthopaedic infrastructure, the AAOS is working with these groups to help find qualified volunteers to teach and give service. For more information about volunteer opportunities in Haiti, email the international department at firstname.lastname@example.org
Maureen Leahy is assistant managing editor of AAOS Now. She can be reached at email@example.com