Haiti and the Road to Recovery: Surviving the Human Aftershocks, Battles with the Cholera Epidemic, and the Anticipation of a New Political Era

Abstract

Where your talents and the needs of the world cross, there lies your vocation. —Aristotle In 1967, Dr. Van Duyn shared his experience at the Albert Schweitzer Hospital in Haiti with the Journal, concluding with an urge to readers to visit the Caribbean country.1 Almost half a century later, we did. Although under different circumstances, the goals were the same—to offer surgical aid. Distinctive to this experience, however, was the opportunity to work at a unique moment in the nation’s history. This was a time at which the already fragile postquake Haiti was facing its first cholera epidemic and the first presidential elections following the disaster. The January 12, 2010, magnitude 7.0 earthquake, which lasted approximately 35 seconds, resulted in an estimated death toll nearing 300,000 and left several thousand injured.2,3 On arrival of our team at the Port-auPrince airport, we began the precarious drive to the locale of Carrefour, where the 70-bed partner hospital, the Hopital Adventiste d’Haiti, built in 1978, was located. The roads were lined with tents for the majority of the drive. The tents, which initially served as temporary living quarters, had become permanent residences for many citizens. Dirt and debris overtook several roads, and next to piles of garbage and rubble, many people were selling food and clothing amid a background covered with posters and propaganda of various presidential candidates. With one x-ray machine, a semifunctional dermatome, and a high dose of enthusiasm, we set to work. The clinics filled quickly, with over 100 patients daily seeking care. Several hospitals were forced to close months after the earthquake as the financial burden overwhelmed the hospitals’ capacities to stay open to deliver necessary care. In addition, there was a shortage of nursing staff, as many died and were buried in collapsed rubble.4 Patients presented with a variety of injuries ranging from burn injuries and ischemic contractures from the earthquake crush injuries, to chronic infections and acute soft-tissue traumas. The inability to obtain early surgical treatment, splinting, and physical therapy at the initial time of injury had converted many relatively “simple” conditions to rather complex cases, with many manifesting with contractures, joint stiffness, and soft-tissue deficiencies. As noted by Prado and Reyes, the expertise of plastic surgeons in soft-tissue handling, burn injuries, reimplantation, and extremity and facial trauma plays a critical role in multiple casualty incidents.5 As one can imagine, there were no shortages of such cases. We performed a number of contracture releases, skin grafts, and traumatic soft-tissue repairs, and worked in collaboration with other teams, especially the orthopedists, in managing patients presenting with nonunion, malunion, hardware exposures, and soft-tissue deficits. Patients were treated with staged wound debridements, vacuum-assisted and definitive closures, management of exposed hardware, and loFrom the Department of Plastic Surgery, Loma Linda University. Received for publication January 13, 2011; accepted January 18, 2011. Copyright ©2011 by the American Society of Plastic Surgeons