Plastic surgeons responding to Haiti earthquake share horrors, triumphs

Jim Leonardo

03/19/2010 at -5:00AM

The catastrophic 7.0-magnitude earthquake that struck Haiti on Jan. 12 left as many as 230,000 dead and 300,000 injured. For a nation already mired in abject poverty, the disaster brought additional suffering. Horrific images of severely injured men, women and children – many trapped beneath the rubble of collapsed buildings in the heavily damaged capital city Port-au-Prince – prompted a worldwide call for humanitarian and medical aid. Around the globe, individuals, organizations and countries gave money and supplies – ASPS donated $10,000 to the Life Enhancement Association for People (LEAP) Foundation, a not-for-profit organization that provides specialized medical services to those in need – to help the more than 1 million displaced Haitians who were crammed into tent cities with limited food, water and other supplies.

It was into this environment that a number of ASPS Member Surgeons willingly inserted themselves, leaving behind the relative comforts of their plastic surgery practices and homes. The physicians interviewed for this article share tales of chaos, horror, disorganization and the challenges of treatment itself in makeshift hospitals amid the rubble and crammed tent cities; however, they differ on how and why they were compelled to enter an environment that each likened to a war zone. In most cases, the experiences caused the return home of a profoundly changed physician.

Some of these first responders relied on the help of humanitarian organizations and related institutions to get to Haiti (see sidebar on page 21); others simply made the decision to get there to help – and made it happen seemingly through sheer willpower. The following reports are presented in the words of a sampling of the many plastic surgeons who journeyed to Haiti to offer their assistance, continuing the specialty’s proud tradition of international service and trauma response in the wake of tragedy.

Eric Lomax, MD, Peoria, Ill.

I was performing surgery in an O.R. in San Juan de la Maguana, Dominican Republic, when the table started to wiggle. I was slightly annoyed that it was being bumped by O.R. personnel until someone said, “Look at the oxygen tank,” which was 4 feet tall and swaying. One of the Dominican physicians crawled under a table, then the floor rolled as if it were liquid – and this is a 12-inch concrete slab. I’d been in earthquakes before, but this was the first one that lasted long enough to hold an entire conversation. It wasn’t long before we heard of the devastation.

We finished our cases and the next morning loaded our equipment and whatever supplies we could find into a van and headed for a beautiful, $3 million clinic that happened to be empty – bureaucracy had closed it down – just inside the Dominican border. There were 1,000 quake victims waiting outside, and our first case involved an early-teenage girl with a fractured tibia that we set with no anesthetic. Her screams pierced our very souls. My wife, Debbie, who’s an RN, later said this scene was the single-most horrific thing she’d ever experienced. This girl was just one of many.

Patients were carried to us on plywood, carpeting, wrought-iron fencing – anything and everything. We just started cleaning, sewing and setting – just doing what we could. We made arrangements for several patients to be airlifted to the United States.

We did this for two days until we ran out of everything – we had no IVs or IV tubing, no needles or anesthesia of any kind, the X-ray machine ran on film and that was out, of course. Understandably, at Day 3 post-quake, there was no coordination and it was impossible to get supplies into the country.

We left Friday afternoon, and not to be dramatic, but I wanted to cry; I didn’t think I’d done enough but my hands were tied. I couldn’t make sutures magically appear. We had a facility, we had patients and we had surgeons – but there were no supplies and no way to get them.

Paul Vanek, MD, Mentor, Ohio

I was on my couch on Friday night, watching a report on CNN about a girl whose family was trying to free her from wreckage by cutting off her leg with a power tool. The next update informed viewers that she had died – exsanguinated in the field. I have three daughters ages 13-18, and it still chokes me up. I said to my wife, “I can’t stand the idea that I’m here; I’ve got to go down there.”

We Googled and Twittered and texted and e-mailed and phone-called every organization that we could until 3 a.m., when we felt that we’d tried every group we could reach. The next day, after two e-mails and one phone call with Project Medishare, I was set to leave on the following Tuesday. I was in charge of a team of four, rounded out by two nurses from the Concord, Ohio-based Lake Health system (of which I’m part) and a physician friend I hadn’t heard from in 10 years who saw news coverage that detailed my efforts to get to Haiti.

Upon arriving we discovered a host of nondefinitive amputation patients with a nearly 100 percent complication rate. Our team, which by now included Swedish surgeons, American orthopedists and others, strove to do definitive surgeries. That was our goal.

I found myself in a “medical center” by name only, in a room we converted into an O.R. – no oxygen, no anesthesia machine, no sterile drapes and we had to scavenge for the “technology” for our surgeries. (It was amazing how much we leveraged every relationship we made on the way down and while we were there for items that we absolutely needed. True horse-trading…) Lake Health donated about 30,000 oral antibiotics and about $27,000 in material. I purchased 3,800 IV antibiotics and spent about $17,000 of my own. This stuff was absolutely life-saving, figuratively and literally.

Our first night found us operating by batter operated headlight with nurses who hadn’t scrubbed before, on a Haitian woman who had half her eyelid avulsed, her face was broken – there was a huge hole in her nose and she was septic. I had an excellent Creole-English translator who told her that it was a very dangerous situation – which allowed me to do a one-stage surgery, challenging under the best of circumstances.

We later treated a man who urgently needed a bilateral amputation; he had had no wound care for days and was so septic that his heart was racing. He was resistant to the idea of an amputation – we sensed he embraced the belief that life without legs wasn’t worth living. But with the translator at my side, I knelt next to him, took his hand and told him: “I love you, and we want you to love your life more than you love your legs.” It was a truly poignant moment.

Our team’s anesthesiologist was brilliant. He combined IV sedation and spinal anesthetics, and employed laryngeal mask airways and had them breathe room air. We did big surgeries – amputations above and below the knee, orbital floor explorations, facial surgeries, fasciotomies, and we tried to do definitive surgeries. When you train in general surgery, followed by a chief residency in trauma surgery followed by plastic surgery training, you have a whole different way of thinking.

While life-and-death scenarios will have lessened tremendously by the time PSN is printed, ASPS Member Surgeons should know they need to get down there now, because people are dying – despite what you hear. There’s a funnel block at the entrance to Haiti, and on the inside there’s a desperate need for plastic surgeons that will continue for months. The outlying areas are not being serviced.

This experience has fundamentally changed me – in an improved way. I feel more calm, more spiritual. I had heard from my mother our whole life that “the Lord will provide,” and now more than ever I’m convinced that’s true. Our community opened up to us when they learned we were going, and it seemed the world stepped up to meet other needs as those arose.

I’m unburdened. I’ll still care as much about critiques, but inside, I know I’ll be OK.

Chad Perlyn, MD, Miami

As a pediatric plastic surgeon on staff with Miami Children’s Hospital, from the minute news of the earthquake broke, I knew I would go. As I got on the phone that night, my wife, who was very afraid for me, began to cry. Yet she and I knew that I needed to go – there was no question. It was the nature of the trauma and number of children injured; as a pediatric plastic surgeon a stone’s throw away from Haiti, it was my imperative.

The day I left, I was a young plastic surgeon just out of training and building my practice. The next day, I’m a team leader of pediatric surgeons and learning quickly how to unload 15,000 pounds of supplies from a Boeing 737’s cargo hold; dealing with the U.S. Army, Marine Corps and the Israeli Army; negotiating with nongovernmental organizations for supplies; and managing – and operating on – 75 children in a single ward located just off the tarmac at the Port-au-Prince airport.

This created a “new normal” for me. From the comfort of an O.R. in Miami, to operating on a picnic table with one Air Force C-130 cargo jet after another taking off on an adjacent runway. I’ve never been in combat, but I have a sense now of how combat surgery might be, only without shooting and shelling. The C-130s above, helicopters hovering, dust everywhere from trucks and the aircraft, military personnel rushing in with wounded – it was like an extended scene from the television show M*A*S*H.

The anesthesiologists there were “block” experts, which meant that they could numb an entire limb with a single injection. This meant very safe, effective surgery. We could sedate the children and have them feel no pain, which let us be very safe and effective while accomplishing major operations under very austere conditions.

However, surgery didn’t pose the greatest challenges. A civilian two-pilot team became nervous when they were about to take off to bring three dying children to Miami. They were concerned that the children’s lack of travel documents would somehow paint them as human traffickers. Although we had arranged the necessary paperwork in Haiti and the United States, they nevertheless developed cold feet and considered unloading the children.

I was notified about the issue and raced to the airfield. Looking both in the eye, I first apologized for what I was about to say, then explained to them that if the children weren’t airlifted, they would die. I tried to be calm while delivering the reality of the situation to them. I said, “If the plane goes, they live; if it stays, they die. If you choose your self-preservation over their well-being, then you have to live with that decision for the rest of your lives.” A few minutes later, patients and pilots were in the air, and today those children are well.

Good impressions have replaced tough ones in the wake of my return. My lasting impression, however, will be of these resilient and gracious people, personified in a beautiful 7-year-old boy. We came to check on him after having amputated his leg. When he saw who it was, with a weak smile he gave us this order: “Please don’t help me anymore. Go help the sick children.”

Craig Hobar, MD, Dallas

I was part of the LEAP team that had joined with another Dallas team and arrived on post-earthquake Day 4. LEAP sent communications that we needed medical personnel and supplies for Haitian relief, and in short order, two citizens with private jets offered to take us. We assembled one team, but then Ale Mitchell, MD, LEAP’s first full-time international development physician, told us we needed another. So we put another team together over the next 12 hours. In situ, this was remarkable.

It really was a completely M*A*S*H-like situation on the ground: all types of aircraft coming and going from all over the world, military personnel on the ground serving as air traffic controllers and barking commands into walkie-talkies, heavy trucks rumbling by and medical tents seemingly sprung right from the tarmac. People were still being pulled from the rubble, and there were a massive number of them who needed amputation to prevent sepsis and death within a short period. I was struck by the sense of this being truly a World War – but with all of us fighting for a united cause. CURE International personnel split us into two teams and brought each to different hospitals. It was a surreal experience: miles and miles of crumbled buildings and houses, a pervasive smell of death and a dysfunctional hospital with dying patients lying on its cement parking lot.

There were many injured children with no parents; they had been killed in the earthquake. I found myself treating an 8-year-old named Gabrielle, who had a severe injury limited to the distal portion of her foot and was gangrenous. We asked where her mommy was, and she replied that she was too badly hurt to be with her. We were able to save her foot by taking off a small portion of her distal foot. When she was able to handle it, we gave her a lollipop – and she was smiling and saying, “Merci, merci.” She became this beautiful, happy kid, smiling and eating this lollipop – yet inside me there was an emptiness. I didn’t know where she would go and how she would get there. And there were thousands of children like this…

Every mission trip I have been on has changed me for the better. But this was something I never imagined, due to its intensity and the pain and suffering that were incomprehensible. I feel that if I ever “go back” to my life as it was, I would miss something I may never get the opportunity to experience again: a slightly higher understanding of why we are here, part of which is, “We begin to understand God’s love for us by passing on our love to others,” and “Our responsibilities to our fellow man do not reside solely within our families, workplace and community.” We have a call to get out of our comfort zone, and it shouldn’t take an earthquake to make it happen.

Two Haitian ladies were standing outside the hospital and near our bilingual driver as he waited for us. He told me later that one turned to the other and said: “I don’t understand – why are all these doctors from all over the world coming to help us Haitian people? Why?” Her friend said, “They’re answering God’s call to love one another.”

Scot McKenna, MD, Dunmore, Pa.

While watching the news coverage, I saw rescue workers and regular citizens on television, screaming for doctors and more medical attention. But the image that really struck me was that of a woman who had been waiting outside a clinic for 24 hours, wearing a tourniquet. I thought: “Even I could’ve done something in that case. They need doctors – and I don’t care if I have to mop floors or do actual plastic surgery.” Something in me just sparked.

After leaving from Newark, N.J., and a 10-hour bus ride, we hit the ground less than a mile from the U.S. Embassy in Port-au-Prince – and it was chaos. Tarps and tents were everywhere, we were triaging patients outside in beds. Getting something done was difficult; I had a hard time getting into an O.R. No one knew who I was, so I taped a piece of paper to my chest to identify myself and my specialty.

One little boy had an ear and arm that was severely burned, and he had lived with that for 12 days. Another 6-month-old came into the E.R., and it broke my heart to see him crying. I ended up operating on the boy to correct a chest wound and a large wound on the left posterior shoulder with a fractured humeral head beneath – and I hope I made a difference. There were so many others like him, too. I was struck by the fact that had many of these severe injuries happened in the United States, we would do a full-court press to save the patient. In Haiti we had to say: “We can’t do anything; give him morphine and hope he’s not in pain as he leaves this world.”

I operated late into each of the three days that allowed for O.R. time. I had hoped to operate a fourth day, leaving one day to travel, but getting out of Haiti turned out to be a very long and occasionally harrowing exercise.

Perhaps due to the fact that I went in with no mission experience, I might have a slightly different perspective from those who regularly do this. One thing that stuck out: All plastic surgeons should consider learning another language. I had two years of French in high school and wish I had done more. Although in this instance we had translators, being unable to speak any language other than English can result in a huge disadvantage for physicians and, more importantly, for the patients.

This has changed me profoundly. I’m looking at life differently now, more relaxed, and if my office manager tells me someone’s not happy because of one stitch, while I will take the complaint seriously, it now seems silly in the big picture. I was getting spam e-mail while in Haiti, and the absurdity of what our culture asks us to prioritize struck me like a thunderbolt. People are dying around me, and I’m somehow expected to care about changing my television service.

John Meara, MD, Boston

Paul Farmer and I met over a decade ago when we were both trainees at the Brigham and Women’s Hospital in Boston. We became reacquainted in 2006 when I returned to Children’s Hospital Boston (CHB) after having worked for nearly five years in Australia. It was then that we began discussing ways of augmenting surgical care delivery within PIH.

I was delivering a lecture at the University of Malta when the earthquake struck; I returned home to Boston as soon as possible, and with the full support of the hospital we assembled a CHB team to go to Haiti under the auspices of PIH.

We arrived eight days after the earthquake, and chaos still reigned. Our team and several others from across the country – including New York University, Mount Sinai Hospital, a team from Grand Rapids, Mich., and a Haitian-American surgical team – met at National University Hospital in Port-au-Prince, which, for all intents and purposes had no cohesive O.R. or health delivery system. Everyone put aside their egos and decided to work together for the greater good of the Haitian people. Within 48 hours, the regional team designations dissolved and we coalesced into a single unit. We essentially became the backbone of operative capacity in that hospital, and we assembled four working O.R.s from the chaos.

On our first night, we were presented with a 4-hour-old newborn boy who had rectal bleeding, the origin of which we couldn’t determine and whom we couldn’t completely resuscitate. We didn’t have access to a lab or blood bank, so an orthopedic surgeon from Michigan donated his O-negative blood – and we transfused 60cc of his whole blood to the infant; there were no other options.

We needed to get the child to a nearby Disaster Medical Assistance Team (DMAT), so we asked members of the 82nd Airborne, who were providing security in Port-au-Prince, to help us deliver the newborn to the facility. Minutes later, at about 2 a.m., our PIH mission coordinator, a Haitian-Creole translator, three new friends from the 82nd Airborne and I were driving around the darkened capital in a then-fruitless effort to find the DMAT. The Airborne guys wouldn’t give up, but after about 90 minutes of driving in this dark, earthquake-ravaged city, we returned to the hospital, where we found Craig McClain, MD, the anesthesiologist from CHB, lying on a steel surgical gurney next to the infant – where he stayed the remainder of the night, in order to monitor his breathing.

We went back out at 6 a.m. and found the DMAT hospital. They provided for initial resuscitation and arranged to have him airlifted to the U.S.N.S. Comfort. One week later, almost miraculously, mother and baby were reunited. The baby is doing well.

Coming home was odd – a most unusual contrast. I went from a country without enough of anything to one that has too much of everything. People here don’t realize that the people of Haiti – men, women, adults and young children – scrounge every day just to find that one scrap of food that might keep them alive. I can speak for our surgical team when I say: There aren’t too many things about which we have a right to get upset; our lives are quite easy. As human beings, we all – particularly physicians and surgeons – have a debt to the rest of humanity, to give something back. Go to Haiti and help. They still need you.

U.S. organizations seeking plastic surgeons for Haiti

The number of U.S.-based groups recruiting volunteers and accepting financial support for medical assistance in Haiti seems to be growing daily. The following is a partial list of those organizations specifically seeking plastic surgeons:

CURE International
(717) 730-6706

InterVol
(585) 922-5810

LEAP Foundation
(972) 392-2111

Operation Giving Back (ACS)
(312) 202-5000

Partners in Health/Stand With Haiti
(617) 432-5256

Project Medishare
(305) 762-6448

Originally published in the March 2010 issue of Plastic Surgery News