By David Brown
Wednesday, January 27, 2010; A09
PORT-AU-PRINCE, HAITI -- Tony Redmond -- a professor of international emergency medicine turned temporary relief worker -- set himself two goals at the end of last week.
He wanted to secure a supply of medical-grade oxygen that would allow doctors with Britain-based Merlin, an international aid agency for which he works, to perform surgery on children. He also wanted to get two grievously burned patients out of a local hospital and into a place that might save their lives.
Redmond's two-day quest epitomizes an essential aspect of relief work here, two weeks after the 7.0-magnitude earthquake: the need to solve problems posed by the logistical impediments to caring for the injured and the ill. For all the skill and experience of the many people like Redmond who are working here, his story shows how the success or failure of relief work in a disaster zone -- and the life or death of patients -- can hinge on determination, nimble thinking and no small amount of luck.
It also shows how impossible it is not to get caught up in the fate of individuals even when confronted with mass casualties.
"You know, we talk about and teach the 'most good for the most people' approach," Redmond said. "But if you are presented with a problem of one particular person, and you think you can do something about it, give it a shot."
Redmond's mission began when a BBC News crew told him about two patients at Hopital Universitaire de la Paix, down the street from Merlin's headquarters at a tennis club: a 26-year-old woman named Jenny and a 24-year-old man named Claude. They were burned when the bank they worked in collapsed, causing a propane tank to catch fire.
The two, swathed in bandages, were getting pain medicine and nursing care but little else. Redmond said he would be back in the morning with Waseem Saeed, a plastic surgeon.
Saeed agreed that the patients urgently needed more care. He estimated that the woman had burns on 60 percent of her body, the man on 40 percent. The estimates were imprecise, especially because the doctors did not take off the bandages, but they were factors in a piece of crucial arithmetic: Add the patient's age and extent of burns, subtract from 100, and the result is the chance of survival. Jenny's was 14 percent; Claude's was 36 percent.
Merlin, which has an operating room in one tent and a post-op ward in another, both set up on tennis courts, could not take them. But both would soon become infected and die if their burns weren't meticulously cleaned, trimmed and covered with skin grafts.
So Redmond set off Friday morning in a Merlin-rented car through the jammed, debris-strewn streets to check out a French civil-military relief team. It had a hospital housing 75 patients in a half-dozen tents off the main road in a shady and undamaged canyon.
A variety of armed guards led him to a man with a high forehead and thin lips who bore a resemblance to Edgar Allan Poe. He escorted Redmond to a second man, who led him to a third.
The cases were explained repeatedly, with the first question always centered on the patients' ages and extent of injury. At one point, Redmond noted that "both are making urine," which meant they weren't in kidney failure or septic shock. After some waiting, Redmond was dispatched to the person who could help, who turned out to be the first man with whom he had met.
From there it was onto the air-conditioned command center, where, after phone calls and consultations, the French said they would try to find a place for the patients and would call Redmond by noon.
In the meantime, there was the problem of finding oxygen. He had heard that the Brazilians might have some, so on to the Brazilian encampment.
There, a soldier escorted Redmond to an air force brigadier general. Did he have oxygen?
Plenty. But Redmond would have to bring his own cylinders.
The relief worker promised to return in the afternoon.
By 2 p.m., three cylinders had been secured, but the French had not called.
Redmond passed the Poe-like man near the front gate to the French area and was again sent on a round of referrals that led back to him.
Would the French take the burn patients?
The hospital on the island of Martinique was full, he was told. No answer as to whether they had tried anywhere else.
As Redmond lingered and tried to engage the Frenchman further, a young man in dark blue scrubs and a stethoscope around his neck walked by, heard English and stopped.
He was Jean Coutineau, an army reservist in his 30s and the only anesthesiologist at the hospital. Redmond told him about the two patients. Coutineau thought awhile and then said that he would take them, pending permission from his superior.
As he waited for the go-ahead, Coutineau answered a few questions about himself -- in nearly accent-free English. He was raised in Paris and now practiced in the French resort town of Nice. His mother was English, from Bolton.
Bolton! Around the corner from Manchester, Redmond's home base. They talked like cousins.
The answer came from Coutineau's supervisor: Yes. With that, responsibility for the two patients passed to the French.
Redmond told Coutineau exactly where to find the two. They were Jenny and . . . what was the man's name? Perhaps Robert.
Redmond returned to the hospital to report that the French would be coming soon for Jenny and Robert. "Robert?" said one of the Haitian nurses. "He's Claude."
Well, call him Robert, Redmond said.
When he stopped by the hospital the next morning, Jenny was gone. An American doctor had taken her somewhere. (She ended up on the USNS Comfort, a U.S. Navy hospital ship.) Claude was still there; the Haitian nurse told him that the French said they would pick him up soon.
Off to the Brazilians. The brigadier general led Redmond to the far end of a gravel lot, where a huge yellow tanker truck sat, filled with liquid oxygen. But the man tending it said he couldn't fill the cylinders without the proper regulator on the end.
Redmond thought that the Hopital Universitaire might lend him a cylinder if he guaranteed to refill it himself -- and perhaps refill some of theirs, too.
It took some persuading, but the administrator agreed to lend him a huge cylinder of oxygen on the condition that it would eventually come back filled. It took three people to carry it to the car.
As Redmond was leaving the hospital lobby, he heard someone calling: "Dr. Tony!" It was a Haitian physician he had met on the initial consultation. The doctor thanked him and said the French had just picked up Claude and were transferring him to Martinique. Then he asked whether he could do anything for Redmond.
Did he have a regulator for an oxygen tank?
Yes, the doctor said.
They went to Jenny's room, where there was a half-empty tank with a regulator on it. Take it, the doctor said, in not so many words. After some difficulty, Redmond got the regulator off, hid it in his hat and left.
The two burn patients were on their way to medical care that could save their lives.
And Merlin had oxygen.
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