Disaster relief in Haiti: a perspective from the neurologists on the USNS COMFORT

Abstract

www.thelancet.com/neurology Vol 9 May 2010 461 On Jan 12, 2010, a 7·0 Richter earthquake in Haiti led to a worldwide humanitarian eff ort, the largest in the US Navy’s history. Over 200 000 people died and countless more were injured and homeless. Within 8 days of the earthquake, the USNS COMFORT docked 2 miles off the coast of Haiti and served as the tertiary medical centre for the region. The range of the neurological cases seen aboard the COMFORT highlights the importance of neurology professionals in mass casualty response. Aboard the COMFORT were a neurologist (a native speaker of Haitian-Creole) and two neuro surgeons from the US Navy, a paediatric neurologist from the US Agency for International Development (USAID), three physical therapists (two from the US Navy and a Project Hope volunteer who is a native speaker of HaitianCreole), and fi ve physical therapy assistants. Another paediatric neurologist at a nearby US Air Force facility at Terminal Varreux was available for consultation. Imaging capability on board included roentgenography, CT, and ultrasound. However, shortly after our arrival, an earthquake aftershock disrupted the CT scanner rendering it unusable, which led to increased use of skull roentgenograms and ultrasound for diagnostic purposes during the fi rst 3·5 days. The on-board laboratory could do haematology, blood chemistry, CSF, microbiological, serum anticonvulsant, and rapid malaria and HIV tests. Essential laboratory assessments that could not be completed in the onboard laboratory were sent to the USA. Electroencephalography (EEG), nerve conduction studies, and electromyography were not available because on previous COMFORT missions there was not a great need for these. Physicians from the COMFORT served as triage offi cers on land and worked with non-governmental organisations (NGOs) and the Haitian Ministry of Public Health and Population to identify patients requiring admission. Triage offi cers adhered to the principle of justice, with an emphasis on admitting patients with earthquake-related injuries. We believe that our management of resource-intensive patients enabled other facilities to assist a larger number of less severely injured patients. Some patients were transferred to the COMFORT from the USS Carl Vinson, USS Bataan, and other ships that arrived in Haiti before the COMFORT. Most patients we saw were remarkably stoic, although reactions varied considerably among patients. For example, a 27-year-old Haitian woman was crushed by her house resulting in an L1 fracture with paraparesis and the death of her entire family. Despite this life-changing event, she did not express sadness to the neurologists. Disaster relief in Haiti: a perspective from the neurologists on the USNS COMFORT