Unbefuckinglievable

January 30, 2010

U.S. Suspends Haitian Airlift in Cost Dispute

By SHAILA DEWAN

MIAMI — The United States has suspended its medical evacuations of critically injured Haitian earthquake victims until a dispute over who will pay for their care is settled, military officials said Friday.

The military flights, usually C-130s carrying Haitians with spinal cord injuries, burns and other serious wounds, ended on Wednesday after Gov. Charlie Crist of Florida formally asked the federal government to shoulder some of the cost of the care.

Hospitals in Florida have treated more than 500 earthquake victims so far, the military said, including an infant who was pulled out of the rubble with a fractured skull and ribs. Other states have taken patients, too, and those flights have been suspended as well, the officials said.

The suspension could be catastrophic for patients, said Dr. Barth A. Green, the co-founder of Project Medishare for Haiti, a nonprofit group affiliated with the University of Miami’s Miller School of Medicine that had been evacuating about two dozen patients a day.

“People are dying in Haiti because they can’t get out,” Dr. Green said.

It was not clear on Friday who exactly was responsible for the interruption of flights, or the chain of events that led to the decision. Sterling Ivey, a spokesman for Mr. Crist, said the governor’s request for federal help might have caused “confusion.”

“Florida stands ready to assist our neighbors in Haiti, but we need a plan of action and reimbursement for the care we are providing,” Mr. Ivey said.

Mr. Crist’s request did not indicate how much the medical care was costing the State of Florida, but the number and complexity of the cases could put the total in the millions of dollars. The expenditure comes at a time when the state is suffering economically and Mr. Crist, a Republican, is locked in a tough primary battle for the Senate seat that had been held by Mel Martinez.

“Recently, we learned that plans were under way to move between 30 to 50 critically ill patients a day for an indefinite period of time,” Mr. Crist wrote in a letter to Kathleen Sebelius, the secretary of health and human services. “Florida does not have the capacity to support such an operation.”

A spokeswoman for the Department of Health and Human Services said the decision to suspend the flights was made by the military, not the federal health department. A military spokesman said that the military had ended the flights because hospitals were becoming unwilling to take patients.

“The places they were being taken, without being specific, were not willing to continue to receive those patients without a different arrangement being worked out by the government to pay for the care,” said Maj. James Lowe, the deputy chief of public affairs for the United States Transportation Command.

Florida officials, meanwhile, said the state’s hospitals had not refused to take more patients. Jeanne Eckes-Roper, the health and medical chairwoman of the domestic security task force for the South Florida region — where the Super Bowl will be played on Feb. 7 — said she had requested only that new patients be taken to other areas of the state, like Tampa.

The Health and Human Services spokeswoman, Gretchen Michael, who works for the assistant secretary for preparedness and response, said the agency was reviewing Mr. Crist’s request for financial assistance. The request would involve activating the National Disaster Medical System, which is usually used in domestic disasters and which pays for victims’ care.

Some of the patients being airlifted from Haiti are American citizens and some are insured or eligible for insurance. But Haitians who are not legal residents of the United States can qualify for Medicaid only if they are given so-called humanitarian parole — in which someone is allowed into the United States temporarily because of an emergency — byUnited States Citizenship and Immigration Services.

Only 34 people have been given humanitarian parole for medical reasons, said Matthew Chandler, a spokesman for the Department of Homeland Security. The National Disaster Medical System, if activated, would cover the costs of caring for patients regardless of their legal status.

Some hospitals have made their own arrangements to accommodate victims of the earthquake, which occurred on Jan. 12. Jackson Health System, the public hospital system in Miami, treated 117 patients, 6 of whom were still in critical condition, said Jennifer Piedra, a spokeswoman. The system has established the Haiti’s Children Fund to cover the costs of treating pediatric earthquake victims.

In the aftermath of the earthquake, Haitian medical facilities were quickly overwhelmed. Since then, medical help has come in the form of mobile hospitals and other aid. Major Lowe said that as medical care had become available in Haiti, the need for the flights had declined significantly. But Dr. Green and nonprofit groups with a presence in Haiti said the need for evacuations remained dire.

“Right now we have in the queue dozens of paraplegics, burn victims and other patients that need to be evacuated,” Dr. Green said. “And other facilities are asking us to coordinate the evacuation of their patients.”

A spokeswoman for Partners in Health, a Boston charity with doctors and nurses in Haiti, said the group had a backlog of patients, many with head, spine or pelvic injuries, who needed surgery that could not be performed there.

Major Lowe said patients could still be evacuated in private planes, but Dr. Green said medically equipped planes were very expensive and generally could carry only one or two patients.

Federal officials could not provide the total number of earthquake patients airlifted to the United States, but Florida seemed to have received the bulk of them.

In his letter, Mr. Crist outlined his state’s efforts to support the rescue effort, helping both the healthy and the sick streaming into the state. “Florida’s health care system is quickly reaching saturation,” he wrote.

The (Air) Cavalry is Coming

From Kleiman:  


Small steps, but I'm grateful for them.  I emailed Hank Asher,  who is one of the patron saints of the docs and nurses at Medishare.  Hank is a real champion, and very direct.  He's going to talk to his buds at the U.N. about the blockaded footpath.


And .... caffeine is coming!  Had a wonderful talk with Jason Kensey, the brains and heart behind Vrooom Foods, with a great line of caffeine-laden energy mints and chews.  Vroom, which already donates a ton of caffeine mints to U.S. troops via Operation Gratitude, was eager to step up to the plate.  Hank will help me get it to PAP from Miami.   


Especially working 15-hour days, having fully awake doctors and nurses is a very good thing.


Thank you, guys! 

Coffeeeeeeee

We have no coffee here.

Spend 10 minutes with nurses or doctors and you'll know that coffee is as important as oxygen.

I've told Kleiman to get us caffeine.

We'll see.

A Shout Out to Pascal

This is from Pascal Goldschmidt, Dean of the University of Miami School of Medicine. A thousand more like this dude and medicine in the States would look very, very different....

http://med.miami.edu/haiti-relief/#dean

Dean's Report from Haiti

Dear Friends,

Our doctors, nurses and staff are doing God's work in Haiti and at home! One week after the devastating earthquake that wrecked the capital city of Port-Au-Prince, our team has established an invaluable urgent care center where hundreds of patients have found refuge, help and life-saving care.

Lying on stretchers, the patients are getting round-the-clock, top-notch trauma care that stabilizes their fractures, provides wound care for skin injuries, burn care, eye care, care for lung injuries and acute kidney failure, etc. Because all urgent care hospitals are full, we are partnering with other nations to exchange patients according to the specific technical prowess of each center. A 13-year-old girl whose flailed chest was wounded by a falling rock needed plastic surgery to cover her rib cage. Her skin, bones and chest muscles had been destroyed by the trauma over a patch the size of the palm of her hand, and her lung movement could be seen through the window of her chest. We took her to the "Corps Medical des Forces de Defense d'Israel" (the Israeli medical camp), where such specialized surgery was available, and traded her for a young man with an arm fracture and a severe back wound, whom we took back in a makeshift ambulance to our camp.

The Haitians are stoic. From the woman who climbs a mountain with four gallons of fresh water on her head for her family and neighbors, to the patients and their families who wait patiently for care, watching the expressions on the faces of their doctors and nurses, they give us a lesson in courage that will be remembered forever! Instructively, right after the earthquake they went back to their regular habits. For food and drink, they go to the local market. For care, they go to their regular hospital. Hence, if the United Nations is to be successful in bringing loads of food and water, they need to be distributed at sites where people go for such needs. The same applies for hospitals: those hospitals that have been wrecked need to be reconstituted with urgent care centers where the old hospital used to be.

. . .

Pascal

Hank Asher's Take on the Relief Effort

From http://www.huffingtonpost.com/hank-asher/saving-lives-in-haiti-gen_b_433950.html

GENEROSITY vs RIDICULOSITY

So many beautiful people from so many countries are doing so many beautiful things. And there's so many organizations planning on making a plan; instead of going to f'n Haiti. The problem is now!!! And the problem is in Haiti, not in committees in air-conditioned offices in DC, NYC or anywhere other than f'n Haiti. Move now.
~Save people's lives now.

- - - - -

University of Miami- Global Institute of UM: has donated more than 100 staff. Dr. Pascal Goldschmidt, the Dean of UM Medical school is from Belgium, goes to Haiti and is coordinating massive efforts himself with Dr. Barth Green and Medishare. YOU GO PASCAL!!! YOU Go UM!!! The most common way a Dean of a Medical School can get fired is to do something financially risky. Pascal is a ROCK with STONES!!! Help Pascal keep his job and save tens of thousands of lives: www.umglobalinstitute.org

RIDICULOSITY Winner
Overall every US Agency and Agent has been great. There was one rogue Customs officer who accused us, actually screamed at us, of using a disaster in Haiti to bring orphans into the United States. Questioning 4 children on my plane with Doctors keeping them alive; a double amputee, one in renal failure, one with 3rd degree burns on 50% of her 19 month old body and one having seizures makes him the winner so far. Agent KILO - You win the dumber than dog snot contest. And KILO you win the nastiest punk I've met in years award. Nothing uglier than a little bit of power.

AMBIGUOSITY
FPL (Florida Power and Light)
We are awaiting an answer back from FPL. I've seen them do miracles in hurricanes; a thousand trucks rolling when the wind was still blowing. Great engineers. It's not about restoring electric to Port au Prince. That will take years. Today, it's about a little power where it's really needed. I hope FPL helps!

When will food and water at the airport be delivered to the hospitals and people in Port au Prince?

Where's the Red Cross hiding in Haiti?

WTF ?? Why Are Some of the U.N. People Such Dickheads!

So here's the deal:

After fourteen hours on your feet in 90+ degree heat, a cold beer is nice. A hot meal is nice too. The hard working volunteers here would walk down a short path to the U.N. cafeteria for a brief respite before collapsing.

Not any more.

The U.N. has blocked off the path. No explanation. Just the one-word catch-all of fools and bullies everywhere: "Security". Nonsense. We don't bring our scalpels with us, and after 14-15 hours, there really isn't a lot of fight left in us anyway.

So we're back to high protein MRE biscuits that taste like fiberboard. And water. We have water. All for no reason.

I texted Kleiman. He hunted down Hank Asher, a wild cowboy enterpreneur, child advocate, and Guardian Angel of Medishare. In addition to flying half the docs here over from Miami and endless support, Asher gave 45 satellite phones to what remains of Pres. Preval's government. Kleiman hopes Asher will get Preval to lift the U.N. embargo on all these menacing nurses and doctors.

We'll see.

Some of what Asher writes is pretty cool. I'll post snips in a second. Not sucking up. He'd smell that in an instant. But he is angry and honest and devoted. Can't beat the combination.

Christine and Her David and Her Husband John

Christine is a dear, sweet woman and her husband John was very attentive. Here they are:

and here's John, David's dad.

You can see that there are still some moments in U.S. history which mean a lot to the folks down here. For you younglings, John's t-shirt has a photo of two of the U.S. track and field stars at the 1968 Olympics, Tommie Smith and John Carlos, giving Black Power salutes from the award stand.

Their baby, David, is just adorable. Even our trauma surgeon turned O.B. teared up a little.

The top shot is Christine in labor....

Friday Night Lights

Dead tired, but writing is a great way to wind down as I crash. I worked 14 hours straight. I've gotten some kind of wretched infection that is draining into my upper lip. One of the docs gave me some Cipro and I seem to be responding. One of the plastic & reconstructive surgeons said he'd drain it tomorrow it if it still badly swollen. I think I'll be fine . . . it just hurts like hell and for a while it looked like I'd been in a fight. Doing much better than I was yesterday.

I am continuing to work with Medishare, which is slowly turning into a real hospital. There are now 300-400 of us, including health care pros, logistics people, techs, etc. We are getting a slow, steady stream of equipment. Hey! We even have O2. Alonzo Mourning (former Miami Heat NBA all-star) and Stuart Miller, a Miami construction magnate, have donated three huge, semi-rigid air conditioned tents. As they get on line, the patients are air conditioned, we're air conditioned. It really helps.

I've been bouncing back and forth between trauma (another gunshot wound) and Labor & Delivery. I did another birth (my fourth, her first, and the doctor's first!). The doc, Mike Sheehan, is an awesome trauma surgeon, but we all work out of our comfort zones here.

That's the mom, Christine. She and her husband John named her son David, after my youngest.

Contagion

We desperately need

• Tamiflu
• Typhoid vaccine
• Meningococcal vaccine

I've been working on this since 6 a.m. Nobody can get us any of this.

Maybe a few less cameras and microphones.

Maybe a few less political celebrities.

Maybe a few less Volunteer Ministers with no health care skills.

That would be a couple tons of medicine right there.

Field Report From One of the Swamped Clinic Sites

This field report, published in yesterday's New England Journal of Medicine, gives a good description of conditions on the ground. But please note: This clinic's proximity to the destroyed prison creates makes for a uniquely troublesome situation that is not typical of many other relief sites.

Published at www.nejm.org January 27, 2010 (10.1056/NEJMp1001015)

The Earthquake in Haiti — Dispatch from Port-au-Prince

Jean William Pape, M.D., Warren D. Johnson, Jr., M.D., and Daniel W. Fitzgerald, M.D.

At 4:53 p.m. on Tuesday, January 12, an earthquake killed or gravely injured hundreds of thousands of people in Port-au-Prince, Haiti. Even more were left homeless. The devastation is incomprehensible.

Chaos followed, since the centers of law, order, and functioning society were destroyed or suffered severe losses. The Haitian national palace, government ministries, and police stations collapsed with major losses of life. The headquarters of the United Nations was in rubble, and hundreds of staff members were missing. Banks, churches, food stores, hospitals, hotels, schools, and communications capabilities were destroyed.

As a result, piles of bodies lay in the streets. The only useful places for providing medical care were empty spaces — parks and fields. A city in need of hundreds of trauma centers had two or three.

Four staff members from the organization with which we are associated, the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (known as GHESKIO), died, several were severely injured, and many lost family members or were left homeless. A few GHESKIO staff members were able to reach our clinic in the center of Port-au-Prince on Wednesday, January 13. Several clinic buildings suffered severe damage and were not habitable. Others were damaged but usable.

The GHESKIO staff saw trauma patients and handed out antiretroviral drugs to patients with AIDS. As word spread that GHESKIO was "open," more patients came, many of them critically injured; refugees began camping on a field next to our clinic.

By Thursday, January 14, we had 1000 refugees, many of them seriously injured. GHESKIO staff members provided chlorinated water to refugees, identified the most critically injured, bandaged them, and provided care. We did not have an operating room.

We communicated with the U.S. Embassy and offered GHESKIO as a site for a field hospital. We now had a functioning electric generator, vehicles, water, an open field, and functioning Internet access. Most important, we had our Haitian medical staff, who could triage patients, provide postoperative care, and translate.

For 3 days, we waited. The U.S. embassy pushed hard, but the airport was the bottleneck. Equipment, supplies, surgeons, and other medical personnel arrived from around the world but could not be coordinated, secured, and moved two miles to our clinic. The U.S. Army and a Department of Health and Human Services (DHHS) field hospital arrived on Sunday, and the hospital was operational on Monday, January 18.

By January 22, ten days after the earthquake, we are focused on three missions. First, we must provide food, water, sanitation, and security to thousands of earthquake refugees. We obtained food from relief agencies but hesitated to distribute it directly for fear of a riot. We therefore hired 40 women who work as street vendors. We provide them with cooking oil and food, which they prepare and distribute free of charge.

Our water comes from a well at GHESKIO. Running water is not available in Port-au-Prince. We initially chlorinated the water in barrels, but we have now obtained six filters.

We need latrines for the thousands of refugees. When we have shovels, picks, and wheelbarrows, we can hire people to dig the latrines. We are beginning to see patients arrive with severe diarrhea and typhoidlike fevers.

Security is now our biggest concern. Five thousand prisoners escaped from the National Penitentiary, which was a short distance from our clinic. They have infiltrated our refugee camp. They are armed and organizing. The U.S. Army protects the DHHS field hospital but is not responsible for the refugee camp or the GHESKIO clinic. The walls around our facility collapsed, and our clinics are open to the streets. There is no electricity in the city, and there are no lights at night. Our clinic staff and the refugees are frightened. It is increasingly difficult and dangerous to distribute food and water. More security forces are needed. A barbed-wire perimeter and solar-powered street lights would make the camp and clinic safer.

The U.S. field hospital initially hired its own Haitian translators, with good English as the primary requirement. Many of the new hires were deportees from U.S. prisons who had just escaped from the penitentiary. We removed them and got Haitian students to volunteer as translators.

Our second mission is to support the field hospital. More than 95% of the medical problems we saw in the first week were trauma-related. The number and severity of fractures are unbelievable. We are now starting to see gunshot wounds. Our DHHS field hospital has 70 U.S. volunteer doctors and nurses providing emergency and surgical care. They are saving hundreds of lives.

We are supporting the American DHHS surgeons. Haitian doctors are triaging in the refugee camp and providing postoperative care. We have obtained a large tent for 100 people from the Swiss Red Cross and are using it as a postoperative center. We are now using the GHESKIO x-ray machine, since the mobile hospital did not have one. We are using our private vehicles as ambulances.

Diesel fuel for vehicles and generators is scarce. The U.S. field hospital ran out of fuel, and we provided them with diesel. We just received a shipment of 2000 gallons from our friends at Partners in Health and the Clinton Foundation, and we were able to get another 1000 gallons from a local supplier.

Coordination between the supply chain and patients is urgent. At present, we do not know the capacity of the different hospitals. A patient may be painstakingly taken to a hospital only to find out that the hospital cannot offer the services needed, either because they are not available or because the hospital is overcrowded. In some cases, it is the availability of surgical supplies, such as external fixators, that can limit services; none are available right now at either the GHESKIO clinic or the University Hospital.

We are working with the minister of health to develop a comprehensive hospital-capacity inventory and information system by dividing the city into regions. We want hospitals to indicate their capacity and the availability of services. Since this information is likely to change every 2 to 3 hours, each hospital should provide hourly updates. This information should be centralized at the Ministry of Health and given to all radio stations to inform the population where to go for care.

Our third mission is to continue providing medications for our 7000 patients with AIDS and tuberculosis. Before the earthquake, we developed an emergency plan for our patients in the event of a political upheaval or hurricane. Patients have been routinely provided with an extra 2-week supply of important drugs. Patients were counseled to come to the clinic if possible or to go to one of four predesignated GHESKIO drug-distribution centers in the city. This plan was put into effect the day after the earthquake and is working.

A GHESKIO clinic team is providing HIV and tuberculosis care. Staff members carpool because fuel is limited. Each car owner receives 5 gallons of diesel. An emergency shipment of drugs was brought to our clinic 1 week after the earthquake by a team from PEPFAR (the President's Emergency Plan for AIDS Relief). They continued to unload medications during a severe aftershock. We are working with drug distributors in the Dominican Republic to organize a truck delivery of large quantities of medication.

We try to contact patients by cell phone, but most patients do not have electricity to charge their batteries. One of our doctors went on a popular radio station to announce that GHESKIO is open and also provided the names of hospitals in the countryside that can provide drugs. About 65% of our patients are coming to the clinic, although public transportation is very limited. Another 15% receive their medications at four designated delivery sites. Approximately 20% of patients are unaccounted for.

Financial and other disclosures provided by the authors are available at NEJM.org.

Source Information

From the GHESKIO Center (J.W.P.) and the Center for Global Health, Weill Cornell Medical College, Haiti (J.W.P., W.D.J.) and New York (D.W.F.).

A slide show is available at NEJM.org.

This article (10.1056/NEJMp1001015) was published on January 27, 2010, at NEJM.org.

Why My Head is Exploding

This says it all . . .

http://www.washingtonpost.com/wp-dyn/content/article/2010/01/26/AR2010012603987_pf.html

In Haiti, aid worker's efforts show lives can hinge on luck and resourcefulness

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.

Have We Sense of Decency Left, at Long Last?

I will blog more about this later. But the lack of dignity offered to our patients is appalling. Some medical personnel -- and nearly all journalists -- wander through taking photos of our patients, some naked, some in the middle of giving birth, and never asking permission.

It is heartbreaking to see a people so desperate for help that they have to accept being stripped of their dignity and being treated like objects.

Hospital Blues II

It's tough to work in this hospital.

It's really pathetic that we can't do better than this. We have nowhere to wash our hands, which is HUGE in any hospital, but especially in these conditions. No clean toilet facilities, no hot meals for patients or staff (although the UN continues to be relatively well fed and housed.)

The Cuban, Germans, and Portuguese are so superior to us in terms of organization, direction, and sanitation. The Israelis have the tightest fucking hospital here. (Even though I don't agree with their politics, they know how to do this right and are doing an amazing job.)

The U.S. is seeing the majority of patients in PAP, but there is no excuse for this sloppiness.

Two Weeks In

Note from Kleiman:

Stef is too swamped to blog so this is my quick update on Tuesday, 1/26.

This afternoon, which brought a call from a United Way director who had 58 doctors with their own supplies and equipment, wanting help with logistics to get their equipment to Haiti. Amazingly, one of the national airlines had told her to call me, even though the supplies and equipment I was supposed to accompany  which has been ready to go for two weeks is still on the ground in Chicago and not set to arrive until tomorrow, the 28th.

Perhaps by the time the docs are ready to go in another two weeks things will be a bit better.

Perhaps.

Kouraj, Cherie -- from Sasha Kramer

Based in Cap Haitian, where damage was minimal, Sasha headed to Port-Au-Prince the day after the quake. She is now blogging about relief efforts, offering a personal, moving account and calling into question some of the reports on CNN. You can follow her blog at oursoil.org or friend her on Facebook. Also please consider donating to SOIL. All proceeds will go toward disaster relief in the next month, and after that their crucial work continues.

You can follow her at http://www.oursoil.org/blogs/sashakramer

January 19, 2010

This afternoon, feeling helpless, we decided to take a van down to Champs Mars (the area around the palace) to look for people needing medical care to bring to Matthew 25, the guesthouse where we are staying which has been transformed into a field hospital. Since we arrived in Port au Prince everyone has told us that you cannot go into the area around the palace because of violence and insecurity. I was in awe as we walked into downtown, among the flattened buildings , in the shadow of the fallen palace, amongst the swarms of displaced people there was calm and solidarity. We wound our way through the camp asking for injured people who needed to get to the hospital. Despite everyone telling us that as soon as we did this we would be mobbed by people, I was amazed as we approached each tent people gently pointed us towards their neighbors, guiding us to those who were suffering the most. We picked up 5 badly injured people and drove towards an area where Ellie and Berto had passed a woman earlier. When they saw her she was lying on the side of the road with a broken leg screaming for help, as they were on foot they could not help her at the time so we went back to try to find her. Incredibly we found her relatively quickly at the top of a hill of shattered houses. The sun was setting and the community helped to carry her down the hill on a refrigerator door, tough looking guys smiled in our direction calling out “bonswa Cherie” and “kouraj”.

When we got back to Matthew 25 it was dark and we carried the patients back into the soccer field/tent village/hospital where the team of doctors had been working tirelessly all day. Although they had officially closed down for the evening, they agreed to see the patients we had brought. Once our patients were settled in we came back into the house to find the doctors amputating a foot on the dining room table. The patient lay calmly, awake but far away under the fog of ketamine. Half way through the surgery we heard a clamor outside and ran out to see what it was. A large yellow truck was parked in front of the gate and rapidly unloading hundreds of bags of food over our fence, the hungry crowd had already begun to gather and in the dark it was hard to decide how to best distribute the food. Knowing that we could not sleep in the house with all of this food and so many starving people in the neighborhood, our friend Amber (who is experienced in food distribution) snapped into action and began to get everyone in the crowd into a line that stretched down the road. We braced ourselves for the fighting that we had heard would come but in a miraculous display of restraint and compassion people lined up to get the food and one by one the bags were handed out without a single serious incident.

During the food distribution the doctors called to see if anyone could help to bury the amputated leg in the backyard. As I have no experience with food distribution I offered to help with the leg. I went into the back with Ellie and Berto and we dug a hole and placed the leg in it, covering it with soil and cement rubble. By the time we got back into the house the food had all been distributed and the patient Anderson was waking up. The doctors asked for a translator so I went and sat by his stretcher explaining to him that the surgery had gone well and he was going to live. His family had gone home so he was alone so Ellie and I took turns sitting with him as he came out from under the drugs. I sat and talked to Anderson for hours as he drifted in and out of consciousness. At one point one of the Haitian men working at the hospital came in and leaned over Anderson and said to him in kreyol “listen man even if your family could not be here tonight we want you to know that everyone here loves you, we are all your brothers and sisters”.

Cat and I have barely shed a tear through all of this, the sky could fall and we would not bat an eye, but when I told her this story this morning the tears just began rolling down her face, as they are mine as I am writing this. Sometimes it is the kindness and not the horror that can break the numbness that we are all lost in right now.

So, don’t believe Anderson Cooper when he says that Haiti is a hotbed for violence and riots, it is just not the case. In the darkest of times, Haiti has proven to be a country of brave, resilient and kind people and it is that behavior that is far more prevalent than the isolated incidents of violence. Please pass this on to as many people as you can so that they can see the light of Haiti, cutting through the darkness, the light that will heal this nation.

We are safe. We love you all and I will write again when I can. Thank you for your generosity and compassion.

With love from Port au Prince,

Sasha

Helpless, Helpless Helpless Helpless . . .

Att: Burn Centers -- Emergency treatment needed for burn patients and patients with compartment syndrome. If you can accept peds or adult patients please call Mark Kleiman 310 306-8094 or 310 709-8924. Stef can try to arrange life flight to Miami if you can transport and accept

0600 -- (Pacific Time) Stef texts me with news of an otherwise healthy 13 y/o burn patient with 3rd degree burns over 30% of his body. He is becoming septic and needs to have his wounds surgically debrided (the dead tissue removed.) This requires blood for transfusions, and other material they do not have.

The Navy will not treat him, but will life flight him to Miami. Stef wants to know if I can get the Grossman Burn Center in Los Angeles to accept him.

0615-- I call Grossman Burn Center and get their answering service, which will not call any of the M.D.s.

0630-- I call one of the hospitals the Burn Center uses-- San Joaquin Community Hospital. The nurse manager for the burn center will not be in until 8 and whoever answers the phone declines to reach her.

0700 -- I have found the nurse manager on Linked In and Facebook and email her twice.

0720 -- I find one of the burn surgeons on Facebook and email her.

0800 -- I call the nurse manager and get her voicemail. I page her and she calls me back at 8:15. She cannot help and redirects me to the Burn Center office.

0830 -- I call the burn center office -- again. They are helpful, but the docs are in surgery.

They will get a recommendation and relay it to Stef.

0900 -- U.S. military is life-flighting him now.

Doctors: Haiti medical situation shameful

from CNN: http://www.cnn.com/2010/OPINION/01/25/doctors.haiti.hardships/index.html?hpt=C2

Editor's note: Dr. Dean G. Lorich is the associate director of the Orthopaedic Trauma Service at the Hospital for Special Surgery and New York Presbyterian Hospital and teaches orthopedic surgery at the Weill Medical College of Cornell University. Dr. Soumitra Eachempati is a medical researcher with a clinical surgical practice and teaches at Weill Cornell Medical College. Dr. David L. Helfet is professor of orthopedic surgery at Weill Cornell Medical College and director of the Orthopaedic Trauma Service at the Hospital for Special Surgery and New York-Presbyterian Hospital.

New York City (CNN) -- Four years ago, the devastating Hurricane Katrina affected millions in the United States. The initial medical response was ill-equipped, understaffed, poorly coordinated and delayed. Criticism was fierce.

The response to Haiti has been the same. The point no one seems to remember is this: Medical response to these situations cannot be delayed. Immediate access to emergency equipment is also crucial.

Within 24 hours of the earthquake, Dr. David Helfet put together a 13-member team of surgeons, anesthesiologists and operating room nurses, with a massive amount of orthopedic operating room equipment, ready to be flown directly to Port-au-Prince on a private plane.

We also had a plan to replace physicians and equipment -- within 24 hours, we could bring in whatever was necessary on a private jet. We believe we had a reasonably comprehensive orthopedic trauma service; as trauma surgeons, we planned to provide acute care in the midst of an orthopedic disaster.

Surgeries were being performed in the equivalent of a ... closet ... amputations were performed with hacksaws.
--Drs. Dean Lorich, Soumitra Eachempati and David L. Helfet

We expected many amputations. But we thought we could save limbs that were salvageable, particularly those of children. We recognized that in an underdeveloped country, a limb amputation may be a death sentence. It does not have to be so.

We thought our plan was a good one, but we soon learned we were incredibly naive. Disaster management in Haiti was nonexistent.

The difficulties in getting in -- despite the intelligence we had from people on the ground and Dr. Helfet's connections with Partners in Health and Bill and Hillary Clinton -- only hinted at the difficulties we would have once we arrived.

We started out Friday morning and got a slot to get into Port-au-Prince on Friday. That was canceled when we were on the runway and was rescheduled for the next day. We were diverted to the Dominican Republic and planned on arriving in Port-au-Prince on Saturday.

That Saturday morning slot also was canceled and postponed until the afternoon. The airport had one runway and hundreds of planes trying to land. But nobody was prioritizing the flights.

Once we finally landed, we were taken to the General Hospital inPort-au-Prince with our medical supplies. We had been told that this hospital was up and running with two functioning operating rooms.

Once we arrived, we saw a severely damaged hospital with no running water and only limited electrical power, supplied by a generator. Surgeries were being performed in the equivalent of a large storage closet, where amputations were performed with hacksaws.

This facility could not nearly accommodate our equipment nor our expertise to treat the volume of injuries we saw.

We quickly took our second option: Community Hospital of Haiti, about two miles away. There, we found about 750 patients lying on the floor. But the facility had running water, electricity and two functional operating rooms.

We found scores of patients with pus dripping out of open extremity fractures and crush injuries. Some wounds were already ridden with maggots.

That truck, loaded with life-saving equipment, was hijacked somewhere between the airport and the hospital.
--Drs. Dean Lorich, Soumitra Eachempati and David L. Helfet

About a third of these victims were children. The entire hospital smelled of infected, rotting limbs and death. Later on, we would judge our surgical progress by the diminishment of the stench.

In our naïveté, we didn't expect that the two anesthesia machines would not work; that there would be only one cautery available in the entire hospital to stop bleeding; that an operating room sterilizer fit only instruments the size of a cigar box; that there would be no sterile saline, no functioning fluoroscopy machine, no blood for transfusions, no ability to do lab work; and the only local staff was a ragtag group of voluntary health providers who, like us, had made it there on their own.

As we got up and running and organized the patients for surgery, we told our contacts in the United States what we needed. More supplies were loaded for a second trip. Those included a battery-operated pulse lavage, a huge supply of sterile saline and the soft goods we needed desperately in the operating room.

The plane landed as planned Sunday night, and the new equipment was loaded onto a truck. Then that truck, loaded with life-saving equipment, was hijacked somewhere between the airport and the hospital.

We had planned to run a marathon round-the-clock operation and leave at 11 p.m. Tuesday. We worked for 60-plus hours without stopping. The plane that would take us home would bring with it not only a new medical staff, but also equipment that was nonexistent in the hospital, or even the country.

These pieces of equipment, two of each, were urgently needed: portable anesthesiology machines; electrocautery machines to stop bleeding after amputations; portable monitors for the recovery room; autoclaves to sterilize equipment; and a lot of orthopedic equipment, which we were quickly using up. The other items were those that were on the previous flight and had been hijacked.

Officials at the Port-au-Prince airport canceled that plane's 6 a.m. Tuesday slot, and the plane never made it to us on time.

We had started to see daylight Monday night, having performed about 100 surgeries, which were mainly amputations, fixing broken limbs and soft tissue debridements. Many of the patients were children and babies.

But on Tuesday morning, a huge number of new patients arrived. The Haitians had heard we were trying to save limbs, and families were bringing their injured loved ones to us.

The hospital was forced to lock down, closing its gates to the angry and frustrated crowd outside. On Tuesday morning, we saw that many of the patients we had operated on were becoming septic and would require additional surgeries.

Jamaican soldiers with M-16s escorted us out ... as the crowd outside saw us abandoning the hospital.
--Drs. Dean Lorich, Soumitra Eachempati and David L. Helfet

RELATED TOPICS

• Haiti
• Port-au-Prince
• Orthopedic Surgery

We finished operating at noon Tuesday, our last surgery assisting an obstetrician on a Caesarean section and helping to resuscitate a newborn who was not breathing.

We decided the situation was untenable. Our supplies were running out, our team was past exhaustion, safety was rapidly becoming a concern, and we had no firm plan to leave or resupply.

A hospital benefactor helped us get to the airport. First, Jamaican soldiers with M-16s escorted us out of the building as the crowd outside saw us abandoning the hospital. We made it to the airport on the back of a pickup, got onto the tarmac, hailed a commercial plane that had carried cargo to Haiti and was returning to Montreal, Canada, and had a private jet pick us up from there.

We were unprepared for what we saw in Haiti -- the vast amount of human devastation, the complete lack of medical infrastructure, the lack of support from the Haitian medical community, the lack of organization on the ground.

No one was in charge. We had the first hospital in the Port-au-Prince area with functioning operating rooms, yet no one came to the hospital to assess how we did it or offer help.

The fact that the military could not or would not protect the critical resupply medical equipment on Sunday, or allow the Tuesday flight to come in, is devastating and merits intense investigation.

There was no security at the hospital. We needed a much higher level of security with strong and clear support of the military from the very beginning.

The lack of support for our operation by the United States is shocking and embarrassing and shows how woefully unprepared we are for the realities of disasters. We came to understand that our isolated operation may work in a mission, but not in a disaster.

We first thought we would support those at the helm but soon realized we were almost the only early responders with the critical expertise and equipment to treat an orthopedic disaster such as this.

Still, nobody with a clear plan is in charge, and care is chaotic at best. Doctors are coming into the country with no plan of what they are going to do, and nobody directing them how to do it.

Surgeons who expect to show up and operate will be mistaken. Without a complement of support staff and supplies, they are of limited to no value.

We left feeling as if we abandoned these patients, the country and its people, and we feel terrible.

Our role back in New York is to expose the inadequacies of the system in the hopes of effecting change immediately. Patients who are alive and still have their arms and legs remain in jeopardy unless an urgent response is implemented.

The quickest and most efficient way to really help now and support the medical staff on the ground is to assess needs, provide equipment and personnel in necessary quantities, and bring them safely and expeditiously into the country and to the hospital units caring for patients.

Upon our departure, we witnessed pallets of Cheerios and dry goods sitting on the tarmac helping nobody. Yet our flight of critical medical equipment and personnel had been canceled, and the equipment that did get through was hijacked.

We implore an official organization to step up and take charge of the massive ongoing medical effort that will be necessary to care for the people of Haiti and their children. And to do it now.

The opinions expressed in this commentary are solely those of Drs. Dean Lorich, Soumitra Eachempati and David L. Helfet