Dispatches from the Brown Community

Makeshift medicine

Orthopaedic surgeon Christopher Born of the Alpert Medical School faculty confers with colleagues at a tent clinic in Port-au-Prince.

Credit: John Poole/Courtesy NPR

About Haiti ...

By TAB Staff  |  January 21, 2010  |  Email to a friend

Christopher Born: “The greatest good for the greatest number of people”

: Dr. Born operates on an earthquake victim. Dr. Born operates on an earthquake victim. Christopher Born, professor of orthopaedics at the Alpert Medical School and chief of orthopaedic trauma at Rhode Island Hospital, is working in Port-au-Prince with the International Medical Surgical Response Team.

Thursday 1/21: The Boston Globe and NPR describe the difficult decisions facing surgeons now working in tents erected in a Port-au-Prince schoolyard, as well as the less than ideal conditions: “Sweltering,” the Globe notes, with rudimentary and temperamental equipment. The report describes Christopher Born of Brown’s medical faculty looking at an X-ray of a woman’s shattered hip and thigh bones and deciding quickly to send her to a full-service hospital.

“At this facility,” Born told the Globe, “we could try to do something, but we might do more harm than good. One of the mantras for disaster medicine is: The greatest good for the greatest number of people.”

Cate Oswald: Keeping the hospitals running in central Haiti

Cate Oswald, a 2004 Brown graduate, is Partners in Health’s program manager for psychosocial support and mental health services in Haiti.

Wednesday 1/20: I am in the Central Plateau, organizing the logistics of running our 10 hospital facilities that are all over capacity with patients hurt in the earthquake, while also working on getting gas, food, water, and supplies into the country to keep the hospitals running. Other colleagues are in Port-au-Prince opening new operating rooms in the general hospitals.

One of the most important efforts I'm involved in is making sure PiH’s 4,000 Haitian employees and their families have places to find shelter, food, water, and psychological support now and in the coming days.

Patrick Moynihan: “The presence of the U.S. military is more and more evident in the country.”

Patrick Moynihan, a 1987 Brown graduate, is director of the Haitian Project’s Louverture Cleary School in Port-au-Prince. He had returned to the United States the day before the earthquake; Moynihan quickly made his way back to Haiti.

Thursday 1/21: The presence of the U.S. military is more and more evident in the country. The airport is secured; however, aid flights continue to disrupt regular traffic. Along with charter flights, the bus is now running to the Dominican Republic.

I picked up the [U.N. Development Program]’s official Earthquake Engineering Evaluation Team. This is a group of 10 specialists sent to determine whether standing buildings are fit for use. They will assist the government agencies of Haiti as well as other international groups. They use green and red tags to mark if a building can be used. We received the expected green tags for our buildings that are currently in use. Then came the happy surprise: They also cleared the original girls’ dorm for use. This building will require some repair for the long term. More importantly, the group has chosen to sleep in this building while they stay for five days to work in Haiti! Mr. Zamy, Louverture Cleary School grad and assistant principal, said, “I will sleep anywhere now!” The students have been singing ever since.

We have begun to receive food supplies. This is great because business interruption may delay the local support we built up during the last semester.

Haiti’s leading librarian offered residency at JCB

Patrick Tardieu: Patrick Tardieu Patrick Tardieu, an eminent Haitian librarian who was forced to flee Port-au-Prince during the earthquake, has received an offer of temporary residency at the John Carter Brown Library.

Tardieu is chief conservator at the Bibliothèque Haitienne des Pères du Saint Esprit and director of the library at the University of Quisqueya. He has been a pioneer in making Haiti’s precious historical documents available to an international community of scholars, both online and in the collections under his supervision.

“It is an honor to be able to reciprocate the generosity Patrick Tardieu has always shown to others and to welcome him to our community,” said Ted Widmer, the JCB’s director and librarian.

The JCB intends to help Tardieu raise funds that will help preserve documents and other materials that are important parts of Haiti’s rich cultural heritage.

Sachita Shah: “Today was the first day I saw some non-earthquake-related patients.”

Sachita Shah, assistant professor of emergency medicine at the Alpert Medical School, is providing front-line care to survivors in Haiti.

Wednesday, 1/20: In just a few days we have our operating rooms up and running and are seeing droves of patients. [We] awoke to another quake this A.M., and the people are all still sleeping in the streets. Surgeries are mainly amputations, some pediatric hands and legs, many adult lower limbs. The emergency room is crazy busy with many trauma victims still being transferred. For example, a septic patient who was amputated with hacksaw at Port au Prince hospital came in the back of a flat bed truck needing a higher amputation with hip disarticulation — though today was the first day I saw some non-earthquake-related patients with simple typhoid and some new fractures related to the earthquake in the A.M.

Patrick Moynihan: “The bodies of the dead are still in inhuman arrangements, in places you do not expect to see them.”

Friday 1/15: It was a relief finally to stand on the [Louverture Cleary] school driveway. The evening was just dark enough to obscure faces, [making] handshakes and hugs more important in communicating than words. It was a wonderful moment of being close and gathered after a period of especially painful separation. I asked Zamy, our prefect of discipline, [how to answer] the question, “When will LCS reopen?” His reply: “It never shut, of course.”

Saturday 1/16: I visited the city today. The bodies of the dead are still in inhuman arrangements, in places you do not expect to see them. It is shocking and drives one to tears. It was hard to see the National Palace crushed. All of America has lost something. I have made many proud visits to this monument of a great people. It was also hard to visit the Caribbean Market, where my kids have enjoyed finding a piece of home as they grew up here. [The market] is completely fallen.

: Patrick Moynihan ’87, third from left, and volunteers remove damaged railings from a school building. Patrick Moynihan ’87, third from left, and volunteers remove damaged railings from a school building. Monday 1/18: Today, with the help of some of our volunteers and two visiting German journalists from Der Spiegel, we carefully began the removal of “precarious elements” — pieces of structure weakened by the quake — that could fall in aftershocks. The first item on the list was the railing on the third floor of the old classroom and the boys’ dorm building. Outside the walls of the school, the U.S. military has taken over responsibility for the airport. This makes one very reassured.

Later I visited the Montana. This nearby hotel had been a place of relaxation for us and our volunteers. Now it is completely collapsed. I thought of the people I have met there and the people trapped under the rubble, one of them a school board member’s niece. I taught Marianna, our youngest daughter, how to dive in the Montana’s pool, and swam races against Chilean and Argentinian military with son Timothy.

We have lost friends. The demolished buildings are tombs, in many cases. This remains the context to each day, but life is the focus.

Steve Sullivan: “The injuries we are treating will require months of care and multiple operations.”

Stephen Sullivan, assistant professor of surgery in the Alpert Medical School, is working with Partners in Health.

Monday 1/18: Dr. Helena Taylor and I are operating in Cange, Haiti, where I have spent a significant amount of time over the last two years. We now have approximately 160 patients in hospital spaces, which include a surgical ward, medical ward, pediatrics ward, a church converted to a ward, and a school converted to ward. There are dozens of other patients waiting to be seen and triaged.

Most of the injuries are fractures and wounds. Many of the fractures have not been treated as we don't have hardware. We are doing our best with reduction, splinting, and casting. Amputations and wound care remain our main operations. The injuries we are treating will require months of care and multiple operations.

Thursday 1/21: Our team, which includes five surgeons, has performed approximately 110 operations. In the last two days, we’ve received a large amount of Synthes ortho rods and fixators – a blessing! There are still many fractures to treat. The next several weeks will be filled with long days in the OR doing wound care, skin grafts, and tissue transfers. Rehab will also be important.

The number of amputees in Haiti has increased by thousands. Even in the States it is difficult to get good prostheses. In Haiti, it will be impossible unless there is a huge investment. Many strong young people will be less able to care for their families unless they receive long-term rehab and care

We feel so blessed with the opportunity to be here at this time of crisis and are so thankful for the team at Brown and Lifespan. Our future work in Haiti will be clinical and also an area of academic development for the program in Global Health, benefiting medical students and residents who join us.

Cate Oswald: “I don’t have words to describe what people are living right now.”

Cate Oswald, a 2004 Brown graduate, is Partners in Health’s program manager for psychosocial support and mental health services in Haiti.

Thursday 1/14: I have just returned from Port au Prince to the Central Plateau, where our Zanmi Lasante (Partners In Health) team sent as many medicines and supplies as we could and will continue to do so as the days and hours progress. I don’t have words to describe what people are living right now. All phone communication is down. With Port Au Prince the epicenter of the disaster, and the epicenter of all things government and business related for the country, the fact that practically the entire population has at least one family member in Port Au Prince means everyone is affected by this tragedy.

We have staff who still can’t locate family members. We haven’t yet accounted for all of our 4,000 employees. All of our ex-pat employees are OK physically. Everyone is in shock — working off adreniline only — but our hearts are aching for all those who are still searching. There are dead bodies everywhere in the streets in Port au Prince, and we’re not sure where to start collecting them all. Tonight as I was leaving the U.N. headquarters, I drove by the national plaza and national palace (destroyed) and there are thousands of people everywhere, sleeping outside. We’re still feeling aftershocks, so no one wants to go back inside homes and many people can’t go back in their homes. The death toll is rising as we speak, and there are a lot of foreigners who are going to be in the death count based on where they lived and the multilevel structures that they lived in.

Some more hopeful news:
Today we mobilized staff to start donating blood, as we are out of blood in the blood banks. We got much-needed supplies to the new makeshift U.N. headquarters (the old one collapsed, killing the head of the U.N.) We were the first and thus far the only group to get anything to the temporary hospital to which all ex-pats and U.N. employees and many injured Haitians were being evacuated. We set up a triage center in Cange in the church and school grounds to receive patients coming from Port au Prince, as our small emergency room was overwhelmed.

We have started surgeries in Cange and Hinche. Many people have started coming to our hospitals as most all hospitals in Port au Prince have been destroyed. Tomorrow we will continue by working in the general hospital in Port au Prince, getting supplies and staff there to continue the work.

We are in need most urgently of blankets, tents, sleeping bags, tarps, water purification tablets, clothes, shoes, socks, winter hats, food, water. It gets cold at night in January in Haiti. Everyone’s in shock and many injured. We need to keep people warm. ... We have a plane coming tomorrow with some supplies and orthopaedic surgeons to help with all the broken bones that need to be pieced together. We’re not so much in need of volunteers from the United States at this point, as it is hard to get people into the country right now and we have a team of 4,000 staff who are responding as well.