Hundreds of patients, many with multiple injuries, had been streaming into Clinique Bon Saveur since the day the earthquake struck. When Dr. Crocker arrived, the hospital was overcrowded, spilling into makeshift wards that had been set up in a church and a nearby school.
“As a hospitalist, my first concern upon arrival was anticipating the likely medical complications we would encounter with a large population of patients having experienced physical trauma,” Dr. Crocker says. “These complications included, namely, DVT and PE events, compartment syndrome, rhabdomyolysis with renal failure, hyperkalemia, wound infection, and sepsis.”
After speaking with their Haitian colleagues, PIH volunteers placed all adult patients at Clinique Bon Saveur on heparin prophylaxis. They also instituted a standard antibiotic regimen for all patients with open fractures, ensured patients received tetanus shots, and made it a priority to see every patient daily in an effort to prevent compartment syndrome and complications from rhabdomyolysis.
“As we identified more patients with acute renal failure, we moved into active screening with ‘creatinine rounds,’ where we performed BUN/Cr checks on any patient suspected of having suffered major crush injuries,” says Dr. Crocker, who used a portable ultrasound to assess patients for suspected lower-extremity DVTs. “As a team, we made a daily A, B, and C priority list for patients in need of surgeries available at the hospital, and a list of patients with injuries too complex for our surgical teams requiring transfer.”
Resume Expansion
Back at the University of Miami’s tent facility, hospitalists were chipping in wherever help was needed. “I cleaned rooms, I took out the trash, I swept floors, I dispensed medicine from the pharmacy. I just did everything,” Dr. Luly-Rivera says. “You have to go with an open mind and be prepared to do things outside your own discipline.”
Volunteers must be prepared to deal with difficult patients who are under considerable stress over their present and future situations, Dr. Luly-Rivera explains. She worries about what is to come for a country that’s ill-equipped to handle so many physically disabled people. For years, there will be a pressing need for orthopedic surgeons and physical and occupational therapists, she says.
Earthquake survivors also will need help in coping with the psychological trauma they’ve endured, says Dr. Reyes, who frequently played the role of hospital clown in the tent facility’s pediatric ward—just to help the children to laugh a bit.
“These kids are fully traumatized. They don’t want to go inside buildings because they’re afraid they will collapse,” he says. “There’s a high percentage of them who lost at least one parent in the disaster. When you go to discharge them, many don’t have a home to go to. You just feel tremendous sadness.”
Emotional Connection
The sorrow intensified when Dr. Reyes returned to work after returning from his trip to Haiti. “You can barely eat because you have a knot in your throat,” he says.