A doctor's story


We amputated the arm of a young man on a table in the open air and no anaesthesia was available

BY 4PM on Saturday, four days after first impact, Port-au-Prince airport is unrecognisable. It is now a US militarised zone and thousands of evacuees with foreign visas or passports wait with hope of a chance to leave on a departing humanitarian aircraft and hundreds of soldiers make camp.

Private jets, military helicopters and commercial airlines carry incoming emergency supplies. A young Haitian man boards a plane and sits down, no passport in sight, desperately hoping that he can stow away – but he is discovered.

The situation is becoming increasingly desperate now for survivors. As a medical doctor, I have worked in Haiti for almost seven years with Partners In Health, a non-profit organisation supporting the government of Haiti in clinics and hospitals in the central part of the country. I have never experienced such suffering.

Already Haiti has the weakest infrastructure and worst health statistics in this side of the world, the highest maternal mortality rate, and the highest under-five death rate, with diarrhoea, HIV, and malaria as major killers.

On a good day having orthopaedic surgery in Port-au-Prince was a luxury that only the rich could afford; now no money in the world can buy that service. Even as aid supplies are coming in now in the days following the shocks, hospitals and clinics in the city have been destroyed. Even if still standing, they were never properly functional in the first place, providing few locations for emergency services to be set up. The government and emergency relief workers search for physical space to set up camps.

By Saturday, approximately five operating rooms were functional in the city, but the majority of injuries that I cared for in the first few hours and days of the tragedy were open fractures and crush injuries that require antibiotics that we did not have. And surgery that we could not perform. With the help of surgeons who had just arrived, 48 hours after I found him on the street where we had both escaped with our lives from cracking buildings, we amputated the arm of a young man on a table in the open air with no available anaesthesia. Not to do so would have left him to die of gangrene.

He remains at risk of death from sepsis and tetanus.

In 2008, four hurricanes destroyed the northwest city of Gonaïves and its surrounding towns and villages, causing a major catastrophe. In 2004, a similar flood caused even more deaths and damage in the same city. Disasters should not be unexpected here. Haiti has more than 10,000 non-governmental organisations registered, including all of the major international “experts” in disaster relief and a Brazilian-led UN stabilisation force.

It must be asked why there was such a limited organised emergency response in the first 48 hours, beyond the humane attempts of survivors to help their neighbours and friends. But now, before the questions, lives must be saved.

Dr Louise Ivers is clinical director at Partners in Health, Haiti. She is originally from Whitehall, Dublin, and is an assistant professor of medicine at Harvard Medical School