Triage, Vodka, and Wilderness Medicine in Haiti

Published January 31, 2010 12:00AM

The videos and pictures showed everything. Search and rescue teams digging through rubble. Haitians praying, then hushing, in hopes of the sound of a loved one. Rescue dogs sniffing for signs of life. Bodies decaying in the streets. Reporters weaving through crowds. Women singing towards the sky in the streets at night. A Haitian boy in the middle of a mob bleeding from the head after a brick to the head. Surgeons amputating limbs with hacksaws sterilized in vodka.

Doctors practiced medicine with primitive tools after the quake. They flew in from the best international medical centers to treat patients under makeshift tents.

Dr. Paul Auerbach arrived with an emergency medical team from Stanford. Auerbach, the founder and former president of the Wilderness Medical Society, knows how to treat medical conditions in the absence of resources and infrastructure. He wrote a footrest of a book on it, Wilderness Medicine. It's a textbook that addresses how to treat some of the worst medical conditions in extreme conditions.

Auerbach established the society to treat people in remote wilderness areas and poor rural areas in emergency situations. Doctors in the rubble of Port au Prince need those skills just as much. Some knew it before they left. One packed the book next to a creole dictionary. Another expressed gratitude for a WMS workshop he attended.

For his part, Auerbach got right to work with limited resources. He updated his healthline blog to provide a picture of emergency medicine in Haiti. Here are a few excerpts from those posts.

January 22
Today's story is about our 5 year old survivor of a week beneath the rubble. He was pulled from the ground and came to our team emaciated, dehydrated, frightened and confused. (For reference, we have heard that some victims under the rubble were forced to try to drink their own sweat and blood from faces dripping into open mouths. I apologize for being graphic, but this is reality.) Our doctors and nurses gently hydrated him, then began to nurse him back to health. He has made a remarkable recovery, as have others. With so many people affected, there will be many such stories, but for each tale with a happy ending, there are thousands with a tragic outcome.

Haiti, January 24
We continue to have new patients enter the compound, including nearly 100 emergency patients today, many with injuries related to the earthquake. This is done in two new triage tents provided by the army. We are receiving patients referred from the countryside and other hospitals. The operating rooms are busy with orthopedic and wound care, skull fractures, hand surgery, facial reconstruction and the like. Neurosurgery is still not ready to go at this facility.

The Swiss have a pediatric surgery service next to our pediatric area. This is a part of the compound that breaks your heart. The tented ward is full of children with multiple amputations and severe injuries. There is no candy coating this – their lives will never be the same. A half a block away, when the wind shifts, it smells of death from bodies buried in the rubble of the nursing building. We have learned to adapt, to walk past this place and wrinkle our noses. We no longer need to wear facemasks.

Our two-tent E.R. continued to be busy. The doctor teams were swift,efficient and resourceful. We added service for HIV patients, and thenumber of patients with tuberculosis increased to the point that wecreated an isolation tent. These patients are coughing and cachectic.On the opposite side of the compound, the population in the pediatrictents in growing rapidly. Unless there is a concerted effort to createan off-site location to house patients that can be discharged from thehospital, there will once again be space problems.

I am so proudof my Stanford colleagues and all the other doctors present in thecompound who have worked tirelessly for the past two weeks. The teamsfrom California, Hanover, Boston, New York, Switzerland, Norway,Canada, Spain, and many other locations all pulled together in a modelfor collaborative behavior. There are always a few people moreinterested in citing their credentials than in getting the work done,and media people looking for the sensational angle, but they stood outin stark contrast to the dedicated and tireless people who rolled uptheir sleeves coming in and hugged going out. Take it from someone whowas, as someone suggested to me, in the belly of the beast that whenthe memories finally register, they will be indelible andlife-altering. I wish the people of Haiti every good fortune from thispoint forward and hope that you will find it in your hearts andschedule to assist these people, and others in need, in some fashion.

The extreme surgical triage has stopped, but the surgeries and treatment continue. The World Health Organization estimates that doctors still carry out 30-100 amputations every day. Left untreated in hot unsanitary conditions, minor wounds fester into life-threatening injuries. The rainy season is coming, and the WHO fears that epidemics may add to a body count feared to already be 200,000. Tetanus, cholera, and diarrhea may take more lives. That's to say nothing of the mental and emotional toll.

After a string of 18-hour days packed with surgeries and logistical headaches, Auerbach has returned home. His skills remain in Haiti in the hands of other doctors who practice wilderness medicine in a city's rubble. They are good skills to have, but the next wave of medical emergencies—diseases, PTSD, diarrhea—will require more.