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Haiti: An Anaesthetist’s Account of a 10-day Mission

Published 03 February 2010

 

Day 1 - Wednesday, January 13: Just a few hours to decide

“I heard about the disaster on Wednesday morning, and the first phone call came through at the hospital a few hours later. MSF wanted to know if I could leave for Haiti right away. I’d already been there on mission twice, in 2006 and 2008, working in MSF's trauma centre in Port-au-Prince. The next day, I was at Mérignac Airport, along with a coordinator, another anaesthetist and two logisticians. We travelled in a cargo plane carrying the supplies needed for a field hospital. We finally took off on Friday morning, with a landing in Port-au-Prince planned for the next day.”

Day 4 - Saturday, January 16: Landing permission refused for the first time in Port-au-Prince

“We circled the capital for two hours, waiting for the control tower’s permission to land. We finally started our descent. But at that moment, the pilot was told to pull the head around and head for small airport on the tip of Santo Domingo. There was nothing we could do about it. We were pulling our hair out. We ended up landing in Samana, in a small airport that wasn’t remotely geared up to receive a plane like ours. A departure was announced for that evening. But once again, landing permission in Port-au-Prince was refused. So everyone jumped into action—the Dominicans were incredibly helpful. We offloaded the 25 tons of supplies from the plane and transferred them on to five trucks. On Sunday, at 6pm, we were on the road, heading for Port-au-Prince.”

Day 6 - Monday, January 18: Arrival in Port-au-Prince

“We arrived at the border at 4am. At 6am we were finally let through and the nightmare seemed over. But we piled into another humanitarian aid traffic jam, and found ourselves snared up in a convoy of nearly 200 vehicles organized by the United Nations. We inched our way forward at three kilometres an hour. At some point, one of our trucks stopped without us noticing, and we were separated, without any news. Then another truck broke down. We finally reached Port-au-Prince on Monday at midday, with three trucks out of five, even though we needed every one. And then our taxi broke down. We left by foot, in the heat, picking our way through the rubble. I crossed this familiar city and I had the impression, six days after the disaster, that it seemed strangely normal. Life had re-started, the streets were full of people, traffic jams. There was neither silence nor cries, just the hum of city life. Then I saw the collapsed houses, crushed under the weight of their roofs. In the streets, passers-by asked us for masks. They may have been scared of epidemics, but it was probably because the corpses smelled bad. They wanted to know what we’d brought, and they were disappointed to learn it was a hospital. They wanted food. On arrival at Trinité hospital, I saw for myself why it was so urgent to get the inflatable hospital through.”

Day 7 – Tuesday, January 19: Surgery in the streets

“I didn’t know that Trinité hospital was in ruins, like almost all the others, and that we were working in the street. The first surgical teams, who’d arrived two days before, had been operating for about 18 hours a day. We operated on wooden tables, in the heat, with the noise of the generators in the background. Night falls at 5pm, and the light fails, so we carried on with head torches for another six or seven hours. The conditions were really dire, but we had no choice. Each procedure had to be carried out that day to avoid the onset of gangrene. Fortunately I had everything I needed for anaesthetics and pain management. The pharmacy was in another building that hadn’t been destroyed. It was complicated and frustrating not having all the equipment at hand. I saw a tetanus case, a child of 10 years old. She was convulsing on the first day, and stiff, with spasms, by the second. Tetanus is hard to treat if you're not properly equipped. You need to administer a sedative to relax the patient, and then monitor her really closely, as her breathing can stop. This patient was on oxygen, and we monitored her as best we could, but it was a hit-and-miss affair. We needed a properly equipped intensive care unit, where there weren’t so many risks. The worst, the most annoying thing, was that we had breathing apparatus in the cargo plane, but as we’d been delayed, it wasn't yet installed. I heard afterward that the little girl had been transferred to another, better equipped facility, so she’s sure to still be alive.”

Day 9 – Thursday, January 21: Working with an experienced team

“There were a fair number of us, six surgeons and five anaesthetists. But it wasn’t too many. Two teams worked in the two operating theatres, carrying out 2 or 3 amputations a day, and new procedures on limbs already amputated. They posed 3 or 4 external fixtures for stabilizing the open fractures. Another team took on 10 to 15 dressings a day; they had to be changed every 24 hours at most. They were major dressings, and often needed changing under general anaesthetic. Then there was the care in the surgical ward, and triage. We took in new patients every day. All the medical staff had the right reflexes, which is hugely precious in massive emergencies like this. For example, when a patient refused an amputation, we left the Haitian Trinité medical staff to explain why the procedure was necessary, to reassure him or her. They soon brought patients around to the idea, speaking to them in Creole. As Trinité was a trauma centre, we'd already dealt with this type of situation. The staff was trained to take the patient’s consent into consideration and manage this sort of difficulty. We also set up systematic vaccination against tetanus in the casualty unit, integrating protocols into the care, which meant that despite these horrendous conditions, we could maintain medical quality.

© William Daniels - Port-au-Prince - January 28, 2010
Jerry stands up for the first time after the operation.

Day 10 –  Friday, January 22: Already time to leave

“I worked for four days, instead of six or seven, because of the landing permission refusals. But I don’t regret coming here. On the medical front, my mission counted a great deal; we were dealing with critical emergencies. And on top of that, it meant a lot to me to work with my former team, to find them again after all they’d been through. I didn’t find it easy at first. I wondered who was alive, who was dead. I dreaded asking the survivors questions about their families. But a deep feeling of solidarity soon gained the upper hand. I’ll go back before the year is over. There’s so much work left to do. The trauma centre was already busy before the earthquake, so just imagine it now.... When I was crossing Port-au-Prince, on my way out, I noticed that nothing seemed to have changed compared to when I arrived. No tents, people were sleeping outside, in public parks, in the streets. No or few distributions, the inhabitants were still hunting around for food. And at the airport, 100 metres or so away from the town centre, I saw row after row of aid supplies, still sitting on the tarmac. This aid had reached Port-au-Prince.”

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