Thursday, January 21, 2010

Nightmare in Haiti: Untreated Illness and Injury

January 21, 2010

Nightmare in Haiti: Untreated Illness and Injury

New York Times

PORT-AU-PRINCE, Haiti — A strong aftershock rattled Haiti once again on Wednesday, causing even more physical damage and further traumatizing the jittery population. But the authorities said the biggest dangers now facing survivors of last week’s major earthquake were untreated wounds and rising disease, not falling debris.

Because of untreated injuries, infectious diseases and dismal sanitary conditions, health workers said that the natural disaster that struck Haiti more than a week ago remained a major medical crisis and that, unless quickly controlled, it would continue to take large numbers of lives in the days and weeks ahead.

“There are still thousands of patients with major fractures, major wounds, that have not been treated yet,” said Dr. Eduardo de Marchena, a University of Miami cardiologist who oversaw a tent hospital near the airport where hundreds of severely injured people were being tended. “There are people, many people, who are going to die unless they’re treated.”

For the seriously ill, the chances of surviving may depend on leaving Haiti entirely. On Wednesday morning, a paramedic rushed up to Dr. de Marchena with news of a newborn who had arrived at another clinic in dire condition. After hearing that the baby could barely breathe, Dr. de Marchena said, “Should I get him airlifted to the United States?”

The paramedic hesitated for a moment, and the doctor said, “Do it.” The baby was soon boarded for medical care in Miami.

In the squatter camps now scattered across this capital, there are still people writhing in pain, their injuries bound up by relatives but not yet seen by a doctor eight days after the quake struck. On top of that, the many bodies still in the wreckage increase the risk of diseases spreading, especially, experts say, if there is rain.

Getting food and water to displaced people is also crucial to staving off more deaths, relief workers said. As of Wednesday, the World Food Program reported that it had distributed food to more than 200,000 people, but it acknowledged that it could take as long as a month for relief food to get to the two million or more people in need.

At some of the hospitals and clinics now treating survivors, the conditions are as basic as can be, with vodka to sterilize instruments and health workers going to the market to buy hacksaws for amputations.

At General Hospital in here Port-au-Prince, the water and power are both out, medical supplies are running low and fuel for generators is hard to come by, doctors reported. Other hospitals are even worse off, though, with patients moved outside into the open air.

Still, health experts were arriving in Haiti from Israel, Cuba, Portugal and other countries, many with stocks of medicine and supplies as well as extensive experience in disaster conditions.

And the United States Navy hospital ship Comfort pulled up off the Haitian coast to handle the worst-off patients. A helicopter landing pad was cleared near General Hospital to evacuate the critically injured there.

But integrating all the health professionals into a coherent system will take time. “Nobody knows how many doctors, how many nurses have come to Haiti,” said Dr. Henriette Chamouillet, head of the World Health Organization in Haiti. “No one is providing the government with the data it needs.”

Another grievance among some health professionals was that the American military was not giving enough of a priority to humanitarian aid. Doctors Without Borders has complained that more than one of its planes carrying vital medical equipment has been kept from landing at the airport here, costing lives.

Despite all the incoming help, Partners in Health, an organization that has been providing health care in Haiti for two decades, estimated that 20,000 Haitians were dying daily from lack of surgery. But that figure was not backed up by other aid organizations in Haiti and appeared to be much higher than other estimates of the continuing death toll from injuries. The W.H.O. said it was just beginning to gather epidemiological data to assess how much the quake’s toll, which is still uncertain, might rise.

One of the keys to bolstering the response, said Dr. Paul Farmer, a co-founder of Partners in Health and deputy United Nations envoy to Haiti, was to unify the disparate aid efforts. “Everyone’s doing their own thing, and we need to bring them together,” he said in an interview.

The continued tremors were not helping the situation. The latest aftershock, which had a magnitude of 6.1, came around 6 a.m. on Wednesday and was centered on Gressier, a village west of Port-au-Prince. The most powerful tremor to hit Haiti since the initial earthquake on Jan. 12, it caused some additional damage to the ravaged capital and surrounding areas, although the United Nations said it was still assessing how much.

At the tented hospital run by Miami doctors, patients were shrieking and trying to squirm out of their cots when the aftershock came. The situation was still more dire at University Hospital, where patients and staff members evacuated the building and many traumatized Haitians feared going back in.

Squatting on the sidewalk in central Port-au-Prince, her thigh bandaged from an injury suffered during the main quake, Ange Toussaint, 55, smiled broadly. “I’m here,” she said. “It happened again, and I’m still here. Wow!”

There were some early efforts to address the psychological toll of the earthquake.

At the University of Haiti, which hardly showed any damage, Jean Robert Cheri, a professor of psychology, sent a team of student trauma counselors into the streets.

“We are sending them out with basic instructions,” he said. “First, listen to people, let them verbalize their feelings. Second, don’t promise them any material aid, because you can’t deliver.”

Mr. Cheri said that the students’ studies had been interrupted for the foreseeable future and that putting their lessons to work would help both them and the country.

“Look, it’s not going to be easy because they’re traumatized themselves,” he said of his students. “I myself am a psychologist who needs therapy. When I go to sleep, I dream of houses falling down.”

Deborah Sontag contributed reporting.

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