The Médecins Sans Frontières (MSF) teams in Port-au-Prince and beyond are still mainly occupied with treating and operating on those who were injured in the quake nine days ago. That has meant a continuing focus on the operating theatres in the larger MSF hospital structures in the capital. But there are new challenges being taken on with the start of mobile clinics in the capital, of water provision and of efforts to plan for post-operative care.

Photo: Julie Rémy, MSF | Medical care continues under tents in front of what was La Trinité trauma hospital and rehabilitation center Pacot. More than a thousand patients have received primary medical care here. Port-au-Prince, Haiti.

With more than 900 patients having passed through MSF's surgical facilities and increasing numbers of patients with renal failure receiving life-saving dialysis, there is already significant need for specialist and sometimes long-term care, such as physiotherapy and psychological support. At the same time there has been an overall expansion of surgical provision in Haiti, as other medical organizations, including the military, have stepped up their work. After-care will soon become very demanding and MSF is starting to organize post-operative care units.  “When you have so many injured people with deep wounds, open fractures and crushed limbs, the more and the faster you can proceed, the better it is,” explains Xavier Lassalle, one of MSF's specialist medical advisors. “But providing for these surgical and medical needs will take months and usually many of these emergency surgical teams stay no more than a few weeks. Most of the wounded have infected wounds in their limbs and they will have to undergo several cleaning operations in theatre, and then often orthopedic and reconstructive surgery. This requires post-operative care for several weeks.” The efforts to secure adequate space for MSF's existing work have been affected by the consequences of yesterday's aftershock. In the Carrefour hospital, which has been one key centre for surgery and general treatment, the team is busy setting up new facilities in a neighbouring school as it has become clear that the main hospital building is no longer completely safe. Additional tents have been erected on the grounds. Meanwhile, specialist engineers checked the stability of the buildings at Choscal and Pacot hospitals after the substantial aftershock, a 6.1 tremor. The Choscal hospital’s operating theatres are safe, but the patients prefer to stay outside in tents. The Pacot building is at risk of collapsing, so MSF is organizing the transfer of the patients to another site. As the inflatable hospital takes shape, MSF staff are preparing for the substantial logistical challenge of transferring the patients who still need operations to the new 100 bed wards. For the first time in this emergency, MSF has started mobile clinics across the city. Teams are beginning in the Carrefour-Feuilles and Delmas 77 neighbourhoods, locating people who are still in need of treatment following the earthquake or who have general medical needs. At the same time, another project has been started to supply drinking water to 7,000 people who have lost their homes. Outside of the city, MSF teams continue to push out into areas where medical care is lacking. Work has just started in Léogâne with surgery and general consultations, while mobile clinics have started to contact people in areas like Grand-Goâve and Dufort, where some 20 people needing major surgery have already been found.

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