Doctors scramble to save limbs crushed by rubble
Although hospitals in Haiti have calmed down in recent days, doctors across the island are now dealing with an overwhelming number of patients with crushed limbs from the rubble, and facing the uphill struggle of trying to save them from amputation.
In the wake of Haiti’s catastrophic earthquake, hospitals across the island are facing the same nightmare: compartment syndrome, or the death of tissue in a sectioned off part of the body, like a limb, a condition that can lead to amputation. Doctors in Haiti see it 100 times a day and, due to the chaotic situation on the ground in terms of resources, see it as one of their most frustrating challenges.
“When a limb is crushed under a concrete block for hours, pressure is created and the muscles stretch and necrotise”, explained Michael Pierrat, a French médecin-pompier (in France a médecin-pompier is responsible for first response medical attention to an emergency call).
Pierrat came to Haiti from Vosges, a town in the east of France, and has been working relentlessly for a hospital in Port-au-Prince for the past two weeks.
“To reduce the pressure, we make an incision in the limb and then we watch to see what happens”, Pierrat said.
If the injured limb experiences complications after this initial procedure, doctors have no choice but to amputate. However, the limited resources in Haiti have turned normal medical procedures into potentially fatal situations, a frustration for many doctors and medical staff across the island.
For Darline, 20, a student who was trapped beneath the rubble of her university for two days, there’s hope that doctors may still be able to save her leg. In the operating room of the hospital - where all exits are left open in the event of another quake - doctors, nurses and anesthetists surround a shaken Darline, who is lain out on the operating table.
"Haitians are now afraid of staying indoors"
“Haitians are now afraid of staying indoors. Even when they’re asleep, they’re terrified of sleeping indoors”, explains a nurse caring for Darline.
The doctors gently elevate the injured leg and undo the bandages. On both sides of the tibia were two large gaping wounds. The areas are cleaned with an antiseptic, stitched up and new dressings are applied. This routine has become a daily procedure for Darline, one that will be repeated until the wounds finally close and heal.
Although doctors had initially thought Darline would be able to walk again in a few months, an anesthetist now comes out of the room shaking his head.
“She has a very low hemoglobin count: 4.1 g per 100 ml of blood. Normally if the count falls below seven, we do a transfusion. I’m worried because each time we take off her bandages, she loses more blood”, the anesthetist sighs. Because there is no blood bank at the hospital, a transfusion is impossible.
The anesthetist suggests to his colleagues the idea of transporting blood from the island of Martinique by plane, but the idea is dismissed by a surgeon at the hospital.
“Once the blood has been sitting on the tarmac in the full glare of the sun for three hours, it’s useless,” the surgeon said.
“We’re losing people for exactly this reason”, the anesthetist explained. “We could lose Darline too”.
"Poorer than poor”
Daytime in Haiti is calm – at least calmer than it’s been in recent weeks.
“It’s no longer as busy as it was in the beginning”, said Pierre Jacquot, a médecin-pompier in charge of coordinating the hospital. “But a lot of people should be coming back to follow up on the treatment they’ve received, and we’re not seeing that happen”.
Jacquot is part of a team of 30 médecin-pompiers sent by France after it received news of the catastrophe.
“I’m exhausted, but I’m not sick of being here. I want to work! When you’ve seen what I’ve seen, you don’t want to stop”, Jacquot said as a man slowly approached the hospital entrance, impeded by a broken ankle.
“We are all impressed by the Haitians’ dignity; they suffer but never complain. I assisted in a birth last week. The mother was a young woman of 16. She gave birth at 4 p.m. and at 5:30 she left the hospital, her baby in her arms and wearing a smile as big as the world”, Jacquot explains after registering the young man with the broken ankle.
Another young woman arrives on a stretcher and Jacquot disappears to assist her. She is 24 years old and also named Darline. Less fortunate than her predecessor, her right leg has been amputated above the knee and her left arm is in a pitiful state.
“We fought for more than a week to try and save her leg, but in the end we didn’t have a choice”, says Jacquot. “Our goal is to try to save the other affected limbs in any way possible. To be handicapped in a poor country is to be poorer than poor. It’s a nightmare”.