Friday, February 5, 2010

In the right place at the right time

HEALING HANDS: Sheridan, left, with anesthesiologist Romero Leina, MD, a colleague from Cuba, at Zanmi Lasante in Haiti

MGH surgeon Rob Sheridan, MD, was walking outside the Partners in Health/Zanmi Lasante Sociomedical Complex in Cange, Haiti, shortly after completing the operating day when he suddenly felt unsteady on his feet. His initial thought was that he'd become dehydrated in the heat. But Sheridan quickly learned that what he felt was a magnitude 7.0 earthquake that had devastated Port-au-Prince, approximately 30 miles away from Cange. Sheridan, who had arrived in Haiti just the day before, was on his second trip to Haiti and his first to Zanmi Lasante as a visiting surgeon and burn specialist.

"That night, a few locally injured patients were seen," he says. "The internet and cell signals were down, and information about the situation in Port-au-Prince was sketchy. No one expected the influx of patients coming out of the city. However, the next morning, large numbers of patients began to arrive from Port-au-Prince in honking cars and trucks."

Patients arrived continually over the next 10 to 14 days and filled the 110-bed hospital. As more and more patients arrived, the hospital was expanded into an adjacent church and nearby school. Many patients rested on mats on the floor. The hospital's two operating rooms ran 12 to 16 hours a day and the nurse-to-patient ratio was approximately 1 to 40. While there were multiple aftershocks, fortunately, the hospital was not damaged and continued to function.

The first patients suffered from acute trauma -- such as open fractures, penetrating injuries from rebar, skull fractures, chest and abdominal injuries, and crush injuries -- many of which necessitated amputation. The age of the patients ranged from infancy through elderly. With minimal X-ray and labs available -- none in the first days -- all decisions had to be made based on clinical exam.

"In the following days, new patients had predominately infected crushed extremities and soft-tissue injuries," says Sheridan. "After seven to 10 days, open fractures or crush-injury-induced renal failure seemed the most common presenting problem in new patients. Most patients had multiple associated lacerations and soft-tissue injuries as well. Orthopedist Dr. Alfred Hanmer from Newton-Wellsley Hospital and two Partners-trained plastic surgeons, Drs. Helena Taylor and Stephen Sullivan, from Providence, joined the group. This allowed an OB room to be converted into a third operating room and increased OR throughput. Additional supplies began to arrive at this time, including military external fixation kits that were extremely helpful."

Sheridan's stay in Haiti was extended beyond his original plan; however, he says that he considers himself fortunate to have been at Zanmi Lasante to help with the earthquake response effort. "It was truly a privilege to work with the Haitian and Partners in Health staff during this emergency," he says. "I’m looking forward to returning to Haiti."

Learn more about the MGH relief efforts in Haiti

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