Jimani, dominican Rebublic, Tuesday, 1/26/10

Today, I went with a part of our team to a field hospital, opened in response to the earthquake, south of Jimani, Dominican Republic.


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This hospital started as a medical mission clinic/OR, not as a hospital.  It had apparently seen little use untilthe earthquake hit and it was cimmissioned as a hospital.  The old orphanage, the building to the left in the map, serves as the less critical area as well as ER/triage.  The building to the right (marked with A) is where the OR's and ICU is.  In the first several days of opening, hundreds of operations were done.  Today, I got to see it when it has calmed down a bit.  The first thing that struck me was the number of amputations.  It is one thing to hear of amputations being done, and another to goto the children's rooms and see them laid out for me 3 at a time. 

My first patient was a 2 1/2 month old baby girl named Noreus. She was found ubder the rubble of a seven story building in Port-au-Princem shieded by the body of her mother and several other adults.
Her aunt had taken her to several Aid stations over the days and all had not been able to see her.  Noreus was only taking water, about 4 ozz. per day for several days.  When she got to Jimani, she was glazed over, dehysrated, and feverish.  She would not wake up or eat.  She also had a bad lacerationon her thigh and a very large, infected pressure sore on her right buttock.
*****WARNING*****

Below is a graphic,disturbing image of her injury

The team here slammmed  some IV fluid in her, started powerful antibiotics, and took her to the OR to remove dead, infected tissue from her wounds.
This morning she is alert and happy.  Her thigh wound is closed.  Her buttock wound is open, with dressings applied.  The wound is very deep.  Her right leg will not move on it's own.  She has no reflexes in that leg.
This hospital at the edge of the Dominican republic has alot to teach us about this disaster. First, that effort to save lives, even in difficult situations, can be effective.  The people running and staffing the hopital at Jimani have been managng an extremely chaotic situation and still attending to the needs of  many people, way more than the original purpose of the building.  On the other hand, I can also see some of the waste that goes into this kind of relief effort.  The side of the  building of the hospital was overflowing with supplies.   Boxes were stacked so high that the bottom rows were getting crushed.  No one there knows exactly what they have out there.  There is a central problem with medical aid efforts like this.  Who comes to help? For better or worse, it's the "Rock Stars" of medicine, the lightning rods for attention--the doctors and nurses.  Doctors, tend to think of themselves as a self -contained show.  We don't see that our efforts depend on someone to organize our stuff, to keep the instruments sterile, to make sense of all the medications.  We recognize that we need nurses, of course.  They are our hands and legs, but we underestimate the need for them, too.  Seeing how things are here convinces me that I should have brought with me 2 nurses, a pharmacist, someone from central supply, someone from housekeeping,and a physical therapist. 

Which brings me to something else I figured out, seeing all the amputees, I realized that this will be an amputee generation in Haiti, and disability will be common.  The time to intervene will be in the next few weeks to months.  The next wave of aid workers needs to be Physical Therapists, Occupational Therapists, and Prosthetists.  These people are hoing to stop dying of their injuries and start trying to live with their disabilities.  The news crews are going to go soon, but the need will not dry up.