Help for Haiti

Keck School responds to earthquake disaster with rapid aid and long-term support

Haiti surgery

Karyn Embrey provides spinal anesthesia in the Israeli Defense
Force hospital as Kara Hammons provides light.

By Leslie Ridgeway

Three days after a 7.0 magnitude earthquake rocked Haiti on Jan. 12, a team of 10 surgeons and nurses from the Keck School of Medicine of USC and the County of Los Angeles Health Services was on its way to the nation’s capital of Port-au-Prince to provide surgical and medical assistance. Three months later, planning was under way to help establish a trauma health system in Haiti, in cooperation with international partners.

The quick response to the crisis was spearheaded by Dean Carmen A.Puliafito, M.D., M.B.A.; Demetrios Demetriades, M.D., director, Trauma and Surgical Critical Care for Keck; and Ramon Cestero, M.D., a Keck School fellow in Trauma and Surgical Critical Care and team leader.

Henri Ford, M.D., vice dean for medical education for Keck and chief of surgery at Childrens Hospital Los Angeles, also traveled to Port-au-Prince to offer his help. A native of Haiti, Ford’s experience went beyond the professional to the deeply personal as he witnessed his homeland facing staggering devastation and uncertain prospects for recovery.

“As the images began to be transmitted, it became clear to me that I had to be there,” he said at one of two town hall meetings organized for the Keck School and the USC University Park Campus upon the team’s return. At the town hall meetings, Ford sounded a call to action, stating, “There will be opportunities for the Keck School and the entire Trojan Family to really play a pivotal role in the building of a new Haiti.”

The USC/LA County Haiti Medical Aid Team, among the first medical personnel to arrive in Haiti, worked in two different areas of the country.

Ford worked with a U.S. Department of Health and Human Services Disaster Medical Assistance Team and International Medical Surgical Response Team that set up a field hospital on the campus of the GHESKIO Clinic, three miles from the epicenter of the earthquake. The GHESKIO Clinic, a Haitian nongovernmental organization that normally specializes in the treatment of AIDS and tuberculosis, had suddenly become the site of a tent city comprising more than 6,000 refugees with a wide range of medical and surgical problems following the earthquake. Ford stayed in Haiti for two weeks.

The group led by Cestero worked with the Israeli Defense Force at the Israeli field hospital near the soccer stadium in Port-au-Prince, and later at a hospital called Double Harvest several miles outside of Port-au-Prince. The team included trauma and orthopedic surgeons, emergency medicine and intensive care unit specialists, a nurse anesthetist, surgical ICU nurse, and a physician assistant. The team was in Haiti for five days.

Amputations and debridements (to clean infected wounds after days without treatment) were common. Cestero estimated his team, working alongside the Israeli hospital personnel, triaged more than 350 patients and performed more than 50 external fixations and amputations over five days.

The surgeons and nurses also tended to internal and head injuries from falling bricks, many sustained by children. Soon after landing in Haiti, Ford was enlisted to perform surgery on a six-year-old boy who had suffered a pelvic fracture and ruptured bladder after a brick wall fell on his abdomen. The boy needed to be airlifted to the aircraft carrier U.S.S. Carl Vinson, and despite his own apprehension about flying in helicopters, Ford went where he was needed.

“While on the ship, the Chief Medical Officer asked me to stay to help with a young girl with penetrating head trauma,” Ford wrote in one of several USC/LA County Haiti Medical Team blog entries. “A roof collapsed on her and a piece of brick was embedded in her skull with extension to the brain.”

Ford was able to remove most of the brick, but it was clear that the girl needed a partial craniectomy. A call went out to CNN chief medical correspondent Sanjay Gupta, M.D., who was in Haiti and is also a neurosurgeon. Ford worked side by side with Gupta and naval surgeon Lieutenant Commodore Kathryn Berndt, M.D., and together they saved the girl’s life.

For all of the heart-wrenching moments, team members also witnessed the resolve of the Haitian people. Cestero’s team worked with a woman who had been trapped in rubble for six days. She was found by her husband, who had continued to search for her even after officials told him there was no hope. Some of her fingers had to be amputated, but there was no mistaking the look of gratitude and relief on the faces of the couple as the woman was discharged from the IDF field hospital.

Ford was in the GHESKIO field hospital when a 31-year-old man who had survived in a collapsed building for 14 days was brought in. The man reportedly had access to water and had only suffered a broken thigh bone.

“This is the most remarkable story I have seen in these past two weeks,” Ford wrote.

The humanitarian mission was not just an opportunity to help. It was a chance to learn valuable lessons about emergency medicine and treatment. “We learned the value of being organized,” said team member Karyn Embrey, certified registered nurse anesthetist. “We learned that when it came to getting resources where they were needed, good intentions were not enough. So many people wanted to help, but they didn’t know where they were needed.”

For LAC+USC Medical Center surgical ICU nurse Claudel Thamas, who like Ford is a native of Haiti, the trip was a sobering experience, but also a chance to help people in desperate need. “It was a tremendous opportunity to serve and be an ambassador for the American people, and to show kindness and compassion to the Haitians,” he said. “There was a tear in my eye when we had to leave.”

In a series of podcasts posted on the USC/LA County Haiti Medical Aid Team blog, team members expressed concern about the immense need for future support in the rebuilding of Haiti, particularly in follow-up care for the sick and injured. At the town hall meeting on the University Park Campus, Ford talked about problems with directing resources where they are needed most.

In an effort to address that concern, in February, Ford returned to Haiti for one week to explore how USC, in collaboration with Project Medishare and the University of Miami, could play a long-term role in enhancing the quality and availability of critical surgical care in Haiti. Ford met with representatives of various hospitals in Port-au-Prince, the Ministry of Health, the U.S. Ambassador to Haiti and representatives of the United States Agency for International Development to discuss the requirements for establishing a trauma health system in Haiti including a centralized trauma/critical care and rehabilitation hospital. Such a facility would be the first of its kind in the entire nation.

In mid-March, the Keck School and Childrens Hospital sent two teams of surgical and medical personnel back to Haiti to provide care at the University of Miami/Project Medishare field hospital in Port-au-Prince. Three members of the USC/LA County Haiti Medical Aid Team traveled to Haiti to conduct an assessment of surgical and medical needs in preparation for sending teams to Haiti on a regular basis.

Dean Puliafito has commended the USC/LA County Haiti Medical Aid Team for their courage and commitment, encouraging others to support Haitian relief efforts. “Individuals can make a tremendous difference, even when their effort seems like a drop of water in a vast ocean. How you answer that call will make all the difference in the world.” •

For more information, see the Haiti medical team blog at www.usc.edu/schools/medicine/haiti_blog/

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