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Lives saved by Stanford team's improvised hospital

- By Ruthann Richter

haiti nurses

When they arrived at Haiti’s University Hospital, they were greeted by a hellish scene—as many as 800 patients with crushed limbs and festering wounds, languishing on filthy blankets amid a pervasive stench of infection and death. And hardly a doctor or nurse in sight.

It was battlefield medicine unlike anything they’d practiced before.

“Seeing those mangled extremities, the amputations and infected wounds, it was overwhelming. There was this feeling that you’d never sleep, there was so much to do,” said Anil Menon, MD, a clinical instructor in emergency medicine and member of the Stanford Hospital & Clinics team that provided emergency care to Haitian earthquake victims.

The eight-person medical team, among the first to arrive in Haiti, spent two weeks treating an estimated 2,000 patients, saving countless lives and establishing an efficient, organized system of care.

“It was a matter of taking 800 patients with these mangled limbs and trying to feed them into the system—prioritizing them—so that you could save as many lives as possible,” said Robert Norris, MD, professor and chief of emergency medicine at Stanford. “At the end, we had set up a pretty respectable tent hospital.”

The team, serving as part of the International Medical Corps, was called in the day after the massive quake hit Jan. 12. They described their experiences there in an interview after their return to the Bay Area on Jan. 30.

The group of four physicians and four nurses arrived in Haiti the morning of Jan. 17 after a tortuous journey, flying into the neighboring Dominican Republic and then hiring two buses to take them into the ravaged country.

“The drive in was mentally taxing—apocalyptic,” said Ian Brown, MD, clinical assistant professor of emergency medicine, describing a sleepless, all-night drive into Port-au-Prince. “Our first taste was the bridge, which was unpassable. We had to take the buses through the fields. Then we were caught in a riot. There were gunshots and people screaming. We were escorted into the hospital by police as the sun rose.”

The grim scene awaited them at the University (National) Hospital, which could not have been characterized as a modern hospital even before the quake, said Paul Auerbach, MD, professor of surgery.

“There were hundreds of patients everywhere—on blankets, mattresses—dirty, filthy,” said emergency nurse Julie Racioppi, RN. The adjacent morgue already had piled up with 500 bodies.

People called out for help, hands outstretched.

The team members immediately sprang into action, each taking on a specific job. The nurses handled tasks traditionally performed by physicians, such as diagnosing problems, and casting and setting broken limbs. One of them, Heather Tilson, RN, set up a clinic to treat injured children.

The hospital had a small, functioning operating room, with only two volunteer surgeons from Massachusetts available to care for the mass casualties. The hospital’s intensive care unit consisted of a single oxygen tank, operated by critical-care nurses from Dartmouth Medical Center. There was no monitoring equipment to diagnose problems.

“Our hands were what we used to assess patients,” Racioppi said.

Fortunately, the team had brought $20,000 worth of desperately needed supplies donated primarily by Stanford Hospital—pain medications, antibiotics, splint material and the like.

“If we hadn’t had those supplies, we would have been crippled,” Norris said.

The team worked nonstop, taking no breaks to eat or go to the bathroom, until night fell. There were no lights in the hospital, and the authorities insisted that they leave the site at night for security reasons.

“It felt wrong, but we had to do it,” Racioppi said. “We had to leave, but we were leaving so much to be done.”

Added Norris: “That was a turmoil—going in the next day and wondering who was still alive.”

The team members spent their nights in a hotel conference center, dining on military rations (not too bad, some said) and recharging for the next day’s onslaught.

Soon they were joined by colleagues from other medical centers and non-governmental organizations—physicians from Columbia University and UC-San Diego, surgeons from Switzerland and volunteers from the Canadian and Norwegian Red Cross. There was a wonderful spirit of collaboration among them all, said Auerbach, who functioned as the hospital’s chief medical officer.

“I can’t imagine a group of people in a situation so difficult being so collaborative,” he said. “It was remarkable. Every single person was just spectacular. They worked hard and got along.”

At the end of the day, they would part with hugs and words of, “God bless you.”

As for the patients, they were truly heroic, often turning away pain medication and rarely complaining, team members said.

“They were all stoic,” Rapiocci said.

“Extremely strong people,” Brown added.

And universally appreciative of the care they received. “You can work a month in the ER here and not get a thank you from a patient,” Auerbach said. “Every Haitian would say, ‘Thank you. I am so grateful.’”

Their generosity was embodied in one patient whom Auerbach found particularly memorable. He was a young boy who had lost one arm and both legs.

“He reached up to me with his remaining hand and offered me his cracker,” Auerbach said.

Gabriella McAdoo, RN, also befriended Monley Elize, a celebrated 5-year-old boy who had emerged from the rubble, arms extended, after being buried for eight days. The boy, featured with McAdoo on network television, was remarkably uninjured. The youngster became attached to the nurse, coming with his uncle to visit her every day. Both of his parents died in the quake.

“It was a sweet experience, and I guess the hardest thing was to say goodbye,” McAdoo said. She has since been in touch with the boy’s aunt in the United States, who hopes to bring the orphaned child here, she said.

The other member of the team was Jonathan Gardner, RN, who formerly worked at Stanford Hospital. Also joining the group were two other emergency physicians, Jessica Pierog, MD, and Rebecca Walker, MD, who are also part of the IMC contingent and remain in Haiti today.

The team said they were very grateful for the support they received from the medical center community.

“From the moment we got the request from the International Medical Corps to mount an emergency response team for Haiti, the outpouring of support, resources, well wishes and prayers was overwhelming,” Norris said.

About Stanford Medicine

Stanford Medicine is an integrated academic health system comprising the Stanford School of Medicine and adult and pediatric health care delivery systems. Together, they harness the full potential of biomedicine through collaborative research, education and clinical care for patients. For more information, please visit med.stanford.edu.

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