Medical Schools, Teaching Hospitals Rush to Help in Haiti
—By Sarah Mann
Few things create havoc that rivals an earthquake. Its sudden, indiscriminate destruction is not prefaced by weather reports or shifting politics. No one is more acutely aware of this grim fact than the people of Haiti — and the hundreds of volunteers, including many from United States medical schools and teaching hospitals, who have gone there to treat them.
As the world now knows, as many as 200,000 Haitians may have died in the Jan. 12 earthquake and its chaotic aftermath. Millions more were wounded. Ghastly injuries literally lay open in the dusty streets. In the days immediately following the quake, a medical team from the University of Miami Leonard M. Miller School of Medicine — some of the first medical personnel to arrive in Haiti after the quake — came upon a 12-year-old girl; a falling rock had removed the skin, bone, and muscle from her chest, creating an opening through which they could watch her lung movement. After providing basic treatment, they transferred her to an Israeli medical team that could provide specialized treatment; her status is not known.
"When we got there, there were no hospitals and really no doctors," said Barth A. Green, M.D., a professor and chair of neurological surgery at the University of Miami who arrived in the Haiti capital of Port-au-Prince within a day of the quake. "We were immediately taken to the United Nations headquarters at the airport, where hundreds of patients were lying with life-threatening injuries and no doctors."
According to rough estimates, Miami is one of about 25 medical schools and teaching hospitals that sent doctors or other aid directly to Haiti. In the two weeks following the quake, academic medical centers raised hundreds of thousands of dollars for victims and donated several tons of medical supplies and other necessities. The AAMC created a new Web page (www.aamc.org/haiti) to highlight member relief efforts, offer resources for responders, and links to disaster relief organizations accepting donations. In addition, the AAMC worked with the U.S. Department of Health and Human Services' assistant secretary for preparedness and response to help identify specialty physicians willing to volunteer medical assistance to the people of Haiti.
"Everyone at academic medical centers would like to help," said AAMC Chief Academic Officer John Prescott, M.D. "A key role for the AAMC is to communicate information to members about how to best respond."
After the quake, supplies and resources in one of the world's poorest nations grew desperately scarce. Green's team improvised repeatedly as they worked on more than 250 patients in their first two days at a makeshift urgent care center at Toussaint Louverture International Airport in Port-au-Prince. One minute, they fashioned casts out of cardboard boxes. The next, an old kitchen table became an operating table.
"They were very unusual and challenging circumstances," said Pascal J. Goldschmidt, M.D., dean of the Miami school of medicine. "I saw more people in dreadful conditions than I ever had before, and facilities were very rudimentary."
Dean G. Lorich, M.D., assistant professor of orthopedic surgery at Weill Cornell Medical College of Cornell University and associate director of the orthopedic trauma service at the Hospital for Special Surgery in New York, led a 13-person team of surgeons and nurses in Haiti. The team had taken their own orthopedic equipment, but still faced challenges because the Haitian facility where they were based lacked blood for transfusions; in addition, limited saline led to rationing. Using only local anesthesia such as nerve blockers, Lorich initially performed amputations with a hacksaw, and later with a power saw.
A team of six physicians and nurses from Denver Children's Hospital used ketamine to sedate patients in a makeshift camp and field hospital. Medical teams cleaned wounds with the pump mechanism from a bottle of hand sanitizer, wrote Jennifer L. Bruny, M.D., assistant professor of surgery at University of Colorado Denver School of Medicine and a pediatrician at Denver Children's Hospital, in a blog detailing the experience.
Some academic medical centers may have been particularly well-positioned to respond because of existing health partnerships in the region. Creighton University School of Medicine in Omaha, Neb., worked through its Institute for Latin American Concern to bring a medical team to the Haitian border town of Jimani. Charles J. Filipi, M.D., a professor of surgery at Creighton, said the institute's infrastructure and personal connections helped mobilize an effective team more quickly.
Weill Cornell also has a longstanding presence in Haiti and runs a program, GHESKIO, that was established to treat HIV/AIDS, tuberculosis, and other diseases. The program is now providing medical care, water, and food to more than 5,000 refugees living on the GHESKIO campus, said Jean William Pape, M.D., GHESKIO director and a professor of medicine at Cornell.
With tens of thousands of victims still in need of care, these teams say they plan to continue their work. Several medical schools continue sending doctors and other aid to Haiti. A second team from Creighton recently joined the physicians already on the ground, and a third is in the works.
The Miami school built a temporary, 300-bed hospital at the Port-au-Prince airport that will include operating rooms, anesthesia, and dialysis and X-ray equipment. The school plans to run the hospital for about two months before turning it over to Haitian authorities.
"Our goal is to give the Haitian physicians the opportunity to take over the center that we've created and then help them find the support needed to transform a tent hospital into a solid-wall hospital," Goldschmidt said. "We'll do everything we can to help the people of Haiti recover."