January 28, 2010 - By Paul Auerbach
(Editor's note: Paul Auerbach and Robert Norris are part of the eight-member team of Stanford physicians and nurses who traveled to Haiti in the days immediately following the Jan. 12 earthquake. They e-mailed this letter about what they and their colleagues have encountered there.)
Because we know that many people will want to have some idea of our experiences in Haiti, we thought that it would be a good idea to give you a brief overview of what the Stanford team encountered, so that you will be prepared to understand the emotions of the team when it returns home. First, we are incredibly proud of everyone. This has been the most intense and rewarding experience of our lives, and we are so grateful for the support we received from the hospital and medical school and the communications from home.
We arrived in Santo Domingo and attempted to catch a flight from a military base in the Dominican Republic into Haiti. That was not possible because of air traffic and the situation. So, we rented a bus and left in the late evening for an all-night ride to Port-au-Prince. For security, we rode behind two buses carrying a Polish search and rescue operation, who agreed to escort us. One hour into the trip the bus overheated and we had to wait for another bus, repack the supplies and get back on the road. We reached the border (where we needed to wait until daybreak for the border to open). Along the way we stopped at a small hospital, to see the hallways and every room packed with victims of the earthquake – horrific limb injuries, burns, crush wounds, etc. They had been triaged and treated by doctors, but it was suboptimal to say the least. This was a harbinger of things to come.
We arrived at the University (National) Hospital in Port-au-Prince at around 9 a.m. We had to weave through the streets behind a police escort to get there, and saw a scene from an apocalypse. The buildings were collapsed, there were milling and agitated crowds pursuing food trucks, and we heard gunshots. None of us had ever seen anything like it.
Stanford's Paul Auerbach, MD, (right) watches as his colleague Ian Brown, MD, performs a curbside sonagram on a pregnant Haitian woman in Port-au-Prince on Jan. 19. Auerbach and Brown have volunteered their time to help victims of the devastating earthquake.
At the hospital, it was a very dire situation. There were only a few doctors and nurses who had gotten in ahead of us, and virtually no ground space was visible underneath a sea of patients. Their injuries were severe – crushed limbs, mangled tissue, open wounds with maggots, fracture dislocations, etc. Some of them had crude bandages, and virtually none of them had a medical evaluation. There were still approximately 40 dead bodies in one area, and the smell of death and cries of pain were everywhere.
We got to work. On that first day, we divided into teams and attempted to see as many victims as we could, mostly to save lives, clean and dress the worst wounds, and bring patients to a very limited operating room to perform amputations. The performance and endurance of everyone were remarkable. The nurses became both doctors and nurses. We injected antibiotics and pain medications, placed splints, and hauled and carried. It was battlefield medicine. When it became dark, we were advised that we had to leave for security reasons. It pained us to do that for humanitarian reasons, but such was the nature of the situation. During that first and next few days, we did not have time to eat or drink much. No one, except the persons stricken by diarrhea, stopped to go to the bathroom.
The next two days were more of the same and we saw a trickle of NGO activity grow into a stream of incoming agencies. Partners in Health, Canadian and Norwegian Red Cross, Swiss surgeons, a team of surgeons from Mt. Sinai, a team of physicians from Columbia University, Hope for Haiti, the Clinton Foundation and others set up shop and performed with astounding ability under the situation and with excellent collaboration.
We experienced multiple aftershocks from the earthquake. On the third morning at 6 a.m. we suffered a 6.1 earthquake and ran from our communal sleeping quarters (a conference room in a hotel). When we arrived at the hospital, all the patients had scattered from the buildings, commingled, and would not go back inside. The temperature outside rapidly climbed to the mid 90s, and we did not have sufficient tents or cover for them, so we began to see heat stroke added to the traumatic mix. We diagnosed tetanus and gangrene and had to continue triaging and treating these badly injured victims out in the hot sun. It was a very hard day for us and an emotional setback.
The U.S. military arrived to secure the compound and offer support (supplies, medics) on the third day. That helped settle the commotion considerably, which was much appreciated by all.
In the first days, the Stanford contingent migrated to fill the most difficult clinical areas, and many of us stayed in them for the duration as they were important and we needed to provide continuity. Ian Brown, MD, and Julie Racioppi, RN, manned a “ward” of 60 to 80 severely injured and medically ill patients – it was a Herculean task that they essentially performed by themselves. At times they had more than 40 patients with pelvic and femur fractures, amputations, sepsis, etc. Anil Menon, MD, and Heather Tilson, RN, worked with Bob to manage two tents of the sickest patients – those slated for emergency surgery, while Bob also coordinated with the military to evacuate patients once we had that capability via the USNS Comfort. Gaby McAdoo, RN, assisted in that area and moved to other areas when needed. Paul worked with John Gardner, RN, to cover all of the patients on the grounds and not in tents, to spot the sickest, treat them and redistribute as necessary and when possible. John was unbelievably proficient – one of the most capable providers with whom we have ever worked.
It is difficult to describe the relentless intensity of the situation. Amid a media barrage and visits by dignitaries and celebrities (such as Bill and Chelsea Clinton, Jesse Jackson, Sean Penn, etc.), we worked from early morning to dark every day, followed by a debriefing with International Medical Corps, a meal that was sometimes military MRE, and then sleep. For much of the time, we slept with a large group in a hotel conference room. Eventually we scored a few rooms and were able to enjoy showers.
As we began to regain some order at the hospital, some of our members joined smaller mobile teams to visit outlying areas and perform assessments and treat persons who lived there or had migrated into enormous tent cities of displaced persons.
As we write this, we are at the end of our 12th straight full day. Bob and Anil continue to lead the interactions with the military, the nurses are performing various essential assignments, including manning the tented ER we have created, which is seeing close to 250 new patients each day, and Paul is coordinating the medical activities of all of the NGOs in the hospital compound, as well as leading the effort to organize a functioning medical center. We are all very tired, and are looking forward to coming home. After we have transferred our knowledge and responsibility to those who will follow us, we hope to fly to Santo Domingo on Friday and back to San Francisco on Saturday.
We are all glad that we came and even more grateful that we were here early. Other than the few individuals who were present within the first couple of days, we encountered the worst situations, which we managed as best we could. It will take all of us some time to process this emotionally. Our hearts go out to the Haitian people who have suffered irreparable losses, yet found the courage and courtesy over and over again to thank us. The people with whom we worked and bonded are among the finest we have ever met.
Thank you, once again, for the tremendous support we received from the entire Stanford community.
Paul and Bob
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