(Wall Street Journal, February 24, 2010)
Emergency Doctors Leave Haiti
By IANTHE JEANNE DUGAN
PORT-AU-PRINCE—Doctors here are bracing for another onslaught of patients, as emergency workers leave the country and thousands of surgeries done after the January 12 earthquake need to be redone.
Between 25% and 30% of postearthquake surgeries will need to be done again to avoid problems, says Dr. Jean "William" Pape, an infectious disease authority who is founder of Gheskio, an HIV/AIDS clinic next door to a field hospital set up by the U.S. Department of Health and Human Services. That estimate is corroborated by Haitian, U.S. and other medical officials involved in coordinating the international medical response, who say the problem is because of the massive numbers of injuries treated in poor conditions in an already weak health infrastructure.
The unusually high level of second operations, along with other mounting medical issues, comes as many emergency medical groups from around the world are returning home. On Wednesday, Feb. 24, the U.S. is pulling its crew out of the field hospital next to Gheskio—the last of a handful of temporary field hospitals that were set up by U.S. health authorities.
Gheskio officials originally expected the U.S. team to stay until mid-March, said Dr. Pape, and were surprised to learn that they had to take over this week. "It is reflective of the confusion surrounding all of this," he said.
Other nongovernment agencies are leaving as well. The USNC Comfort, a medical ship, also is phasing out patients. It has 50 patients currently, and is taking no more.
"We are moving from the immediate emergency phase responding to the direct consequences," said Dr. Ronald Waldman, the U.S. health emergency coordinator, who has been stationed in Port-au-Prince since shortly after the earthquake. Now, he said, medical aid is moving to a second stage "to make sure that people who are displaced don't suffer from indirect consequences."
The shift threatens to overwhelm the medical community here. Many health-care facilities remain unusable, and new cases of diarrhea, malaria and other diseases are picking up in tent communities crammed with tens of thousands of people who lost their homes.
"If you want to spread tuberculosis, jam a bunch of people into tents next to each other," said Warren Johnson, a Gheskio co-founder who is director of the Center for Global Health at Weill Cornell Medical College. "The second phase promises to be as cruel as the first."
In the field hospital next to Gheskio, about 50 workers tended to more than 3,000 earthquake victims. Guards from the U.S. Army's 82nd Airborne division protected the hospital. The hospital saw 150 to 200 patients a day, according to Helen Miller, the chief medical officer there.
"It is hard to see where the emergency ends and where the line to recovery begins in this situation," she said.
She said that the equipment, including big tents that made up operating rooms, a tuberculosis area and others would remain. But the Army will leave along with the medical team.
Gheskio will take over the field hospital, with help from the Caris Foundation, a Texas nonprofit that aids impoverished people, and Weill Cornell. The hospital will become a rehabilitation center and treat common diseases, as well as redoing surgeries.
Dr. Waldman said many people with amputations need to have their initial surgeries fixed so they can be fitted with prosthesis. "Because of the nature of this disaster and the nature of injuries to the survivors, that first emergency part is really not going to go away for some time," said Dr. Waldman.
Dr. Pape said that surgeries were done hastily under poor conditions. Makeshift operating rooms weren't sterile. Some wounds came in so dirty that they now have bone infections. Stefano Zannini, the chief of mission at Doctors without Borders in Port-au-Prince, said Port-au-Prince lacked operating theaters and surgeons after the earthquake and some patients refused to be operated on indoors.
Gheskio is seeing its own AIDS and tuberculosis patients while trying to care for 6,300 refugees who moved onto the clinic's property, clinic officials say. More than 1,000 children are under 5 years old.
Gheskio workers ask daily whether refugees have fever, diarrhea, cough or skin lesions, the clinic says. Meanwhile, Gheskio is making plans to try to move the entire tent city to higher ground before rainy season begins in April.