Friday, March 26, 2010

In Haiti, Affirming a Life of Medicine

In the busy tent that served as part Operating Room and part Intensive Care Unit, Pediatric Surgeon David Lawlor, MD, tapped into skill reserves beyond the expertise he uses every day at MassGeneral Hospital for Children.

In the week after the 7.0 magnitude earthquake, Lawlor and others from the International Medical Surgical Response Team (IMSuRT) East landed in Haiti, where they responded to everything from open wounds to heart failure, meningitis and prematurity.

A specialist in general surgery and burns, Lawlor saw a case of neonatal tetanus and another of full-blown classic tetanus in an 18-year-old, something he says even 65-year-old surgeons have never seen.

Read about the work of other MassGeneral Hospital for Children clinicians in Haiti:

Marjorie Curran, MD
Paul Firth, MD
Jennifer Kasper, MD
Robert Sheridan, MD

“These are things that you don’t see here” [in the United States], Lawlor says. Tetanus, a bacterial disease, is prevented by a vaccine that is widely offered in the US.

“The people who are going to join up with teams like this have to be willing to do medicine outside of their general comfort, outside of their specialty,” Lawlor says.  

Members of IMSuRT undergo strict training to ensure they are ready for demanding situations like the aftermath of natural disasters. Lawlor joined IMSuRT in 2000 and traveled to Iran in late 2003 after the earthquake in the city of Bam.

Repairing damage

In the first three weeks of the combined IMSuRT/Disaster Medical Assistance Team (DMAT) mission to Haiti as part of the National Disaster Medical Service, Lawlor says the clinicians had seen 3,000 patients, admitted 1,500 patients, and performed 500 procedures, 250 of which were significant enough to require sedation.

Lawlor estimates that about half of the patients were treated for illnesses and injuries unrelated to the earthquake.    

“The quality and availability of medical care there was limited [to begin with],” Lawlor says.

Haiti is one of the world’s most impoverished countries, with a large population of young people. Lawlor estimates about 30% of the patients he saw there were children.

One of the most jarring cases Lawlor saw was that of a 14-year-old boy with pneumonia and late-stage rheumatic fever, an inflammatory disease that can develop as a complication of untreated or poorly treated strep throat. As a result of the rheumatic fever, the child was suffering from mitral valve regurgitation, when the central valve between the two heart chambers doesn’t close tightly, allowing for blood flow back into the heart.

The child was flow to a hospital in Florida, where Lawlor expects he underwent mitral valve repair or replacement after treatment for pneumonia.

“That child would have died in Haiti,” Lawlor says.

In the large tent, Lawlor worked for two weeks alongside paramedics, emergency medical technicians and nurse practitioners, among other surgeons.

“These people are highly motivated and very qualified,” Lawlor says, adding they “synch up very fast,” to become an efficient team.

Lawlor’s tent was in high demand with seven ventilators, the most in the Port-au-Prince region. Nevertheless, the shortage of machines left members of the team ventilating a child for 24 hours a day by hand.

Lawlor worked 16-hour days and was available for pediatric emergencies. At night, he and his teammates slept in tents or cots with mosquito netting.

For himself and the other clinicians, Lawlor says the experience, “affirms … the motives that brought them to medicine in the first place.”

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