[Fresh Ink] Haiti: Obama's Katrina (by American MD's)

[Richard Menec]

[why this statement is filed under and falls under the category "OPINION" is 
a mystery, but then this is the Wall Street Journal ! What IS surprising is 
that this statement even appears here.....rm]

<<On Wednesday, the day after the quake, we organized a relief team in 
cooperation with the U.S. State Department and Partners in Health (a 
Boston-based humanitarian organization) to provide emergency orthopedic and 
surgical care. We wanted to reach the local hospitals in Haiti 
immediately-but were only allowed by the U.S. military controlling the local 
airport to land in Port-au-Prince Saturday night.>>

http://online.wsj.com/article/SB20001424052748703808904575025091656446622.html#mod=todays_us_opinion

JANUARY 26, 2010.

OPINION

Haiti: Obama's Katrina

By SOUMITRA R. EACHEMPATI, DEAN LORICH AND DAVID HELFET

Four years ago the initial medical response to Hurricane Katrina was ill 
equipped, understaffed, poorly coordinated and delayed. Criticism of the 
paltry federal efforts was immediate and fierce.

Unfortunately, the response to the latest international disaster in Haiti 
has been no better, compounding the catastrophe.

On Tuesday, Jan. 12, a major earthquake overwhelmed a country one hour south 
of Miami whose inhabitants include American citizens and their relatives. 
Thanks to the Internet, pictures of the death and destruction were familiar 
to the world within hours, and the need for a massive influx of relief and 
specialized medical care was instantaneously apparent. While particular 
fatalities such as head injuries or massive blood loss are rarely treatable 
in mass casualty situations, delayed deaths from infection may be 
preventable.

On Wednesday, the day after the quake, we organized a relief team in 
cooperation with the U.S. State Department and Partners in Health (a 
Boston-based humanitarian organization) to provide emergency orthopedic and 
surgical care. We wanted to reach the local hospitals in Haiti 
immediately-but were only allowed by the U.S. military controlling the local 
airport to land in Port-au-Prince Saturday night. We were among the first 
groups there.

This delay proved tragic. Upon our arrival at the Haiti Community Hospital 
we found scores of patients with pus dripping out of open fractures and 
crush injuries. Some wounds were already infested with maggots. 
Approximately one-third of the victims were children. Most of the patients 
already had life-threatening infections, and all were dehydrated. Many had 
been waiting in the hospital compound for days without water, antibiotics or 
even pain medicine. The hospital smelled of infected, rotting limbs.

Our team spent the next 60 plus hours performing a variety of operations 
including orthopedic repairs to broken limbs and amputations. Sadly, a limb 
amputation in an underdeveloped country may be a death sentence.

We tallied over 100 operations between four surgeons and three orthopedic 
fellows (medical doctors getting additional specialty training), and 
evaluated perhaps 100 more patients for surgery. In contrast, a busy night 
in a New York City hospital might include four or five surgeries. Hindering 
the effort was an absence of ventilators, anesthetic machines, and oxygen 
tanks. There was no blood bank or laboratory, and a dearth of surgical 
instruments. Due to the lack of resources, we know many patients may still 
succumb to infection and other postoperative complications.

The U.S. response to the earthquake should be considered an embarrassment. 
Our operation received virtually no support from any branch of the U.S. 
government, including the State Department. As we ran out of various 
supplies we had no means to acquire more. There was no way to transfer 
patients we were poorly equipped to manage (such as a critically ill newborn 
with respiratory distress) to a facility where they would get better care. 
We were heartbroken having to tell patients suffering incredible pain we 
could not perform their surgery for at least a day.

Even after hearing gunshots outside the hospital, we had no protection for 
ourselves or our belongings-though we observed that a Jamaican medical team 
came with armed guards.

All these problems stemmed from ours being an isolated operation, a feature 
that may work in a humanitarian medical mission but not in a disaster 
situation. Later, as we were leaving Haiti, we were appalled to see 
warehouse-size quantities of unused medicines, food and other supplies at 
the airport, surrounded by hundreds of U.S. and international soldiers 
standing around aimlessly.

With an organized central command dedicated to medical relief, we could have 
done much better. A reconnaissance team, managed by government or U.N. 
officials in conjunction with medical and logistic specialists, could have 
immediately come to Haiti to evaluate local facilities. Preapproved groups 
of experienced civilian and military medical teams could have been 
consolidated in the U.S. from the Pensacola, Fla., military base or other 
locations, to avoid the airplane traffic clutter and delays that plagued 
landing of people and supplies into Port-au-Prince. Targeted teams with 
military support could then go to adequate facilities where they could be 
most effective.

After the disaster, certain roads should have been secured to allow the 
transfer of patients or supplies. A base hospital could have been 
established for patients requiring specialized services (such as a neonatal 
ICU and neurosurgery). A specialized, postoperative care center should have 
been established. In our case, however, we lacked the resources to ensure 
that patients were receiving basic wound care, antibiotics, nutrition or 
hydration.

The death toll from Katrina was under 2,000 people. Deaths in Haiti as of 
yesterday are at least 150,000. Untold numbers are dying of untreated, 
preventable infections. For all the outcry about Katrina, our nation has 
fared no better in this latest disaster.

Dr. Eachempati is a trauma surgeon and incoming president of the New York 
State Chapter of the American College of Surgeons. Drs. Lorich and Helfet 
are orthopedic surgeons. All practice at the Weill Cornell Medical Center in 
New York City.

Printed in The Wall Street Journal, page A17

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