Rapport de l'association des Médecins Haitiens.

AMHE Medical Relief Report, Jan. 25, 2010

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Progress Report 1/25/2010

AMHE Relief Mission group

The Association of Haitian Physicians abroad deployed today to
Port-au-Prince another contingent of Physicians and Nurses divided into two
groups. I st group leaving from JFK will arrive to Haiti via DR.

Jean Bernard Poulard, MD Team Leader, Georges Angus, MD, Team leader,
Micheline Dole, MD, Julius Garvey, MD, Lionel Lefevre, MD, Calvin Mathieu, MD
,Emmanuel Hostin, MD, Gardy Joseph, MD, Anthony Boutin, MD, Gerald Augustin,
PA, M Ortelou, Boyer, RN, N. Carvallo PT, Ridgeley Ochs, John Williams, Carole
Dubuche MD, Sabrina Jasmin RN

2nd group leaving from Florida should arrive early morning.Vladimir
Berthaud MD , AMHE Team leader, Nissage Cadet, MD, Vascular Surgery , David
Young MD, Surgeon Trauma and Critical Care, Gregory Dale-Casey MD, Surgeon
Trauma and Critical Care, Jean Claude Desmangles MD, Pediatric Endocrinology,
Vernat Exil MD, Pediatric Cardiology, Rubens Pamies MD from Nebraska U. Many
nurses are included.

If we are replacing individuals who had returned, we clearly have sent so
far a total of 150 medical personnel ( FL and NY) to the center of this
horrific disaster. We are grateful to Voluntary Ministries for using their
planes free of Charge. We thank the members who have paid their own ticket to
help Haiti.

Our AMHE Relief Mission team in the field in Port au Prince are Dr
Pierre-Paul Cadet, Maxime Coles, MD orthopedist, Dr Mildred Olivier ,
ophthalmologist and Dr Serge Pierre Louis Neurology. Dr Cadet is working with
Haitian Red Cross to develop better logistics: tent accommodations. . etc. If
you need any of these above specialists, just call

Dr PP Cadet at the General Hospital +37896363. In the states, email us at
amhereliefmission@ amhe.org,

)Dr Andre Vulcain a native of Leogane presents his report. Read it to
understand why we need a long term commitment to Haiti.

I traveled to Haiti the same day the earthquake stroke.

I landed in Port au Prince at noon time and my plan was to go the same day to Cap Haitien where we are operating our program . Because of the bad weather conditions in the
northern part of the country, I decided to spend the night in Port au Prince
and to fly the next day to Cap.

I checked in the Visa Lodge Hotel, in the vicinity of the International Airport at about 2PM.
I was in my bedroom at the hotel when the earthquake hit. Fortunately, for me personally, it was more of a big scare than real harm. I was emotionally shaken but physically fine.

The hotel was also fine . Overnight, various reports coming from outside of the hotel started to mention widespread destruction and many deaths. The next day, I actively looked for my immediate relatives and I toured the city to have an idea of the damages.

My relatives were OK, even though my sister- in- law and my niece came out miraculously of the rubble of their heavily damaged home with some mild to moderate contusions.

People on the streets were shell-shocked and some neighborhood looked like they had been bombed. Dead people were lying on the sidewalks and the valiant Haitian people, in an impressive demonstration of solidarity and compassion, were the first bare- hand responders without support or guidance from the authorities, trying frantically to extract some unfortunate victims from the rubble. Some of them died hours after been removed
from the collapsed houses without a modicum of medical assistance.

On Post earthquake Day 2 , I ended up in Delmas 75 at my aunt’s house .
I got the news of the UM hospital by the airport being set up, but I couldn’t reach them due to a lack of fuel in the vehicle I was using and the chaotic traffic on the roads leading to the airport .

I heard about an orphanage providing care to the victims at walking distance of where I was staying. I went there and I met two Haitian doctors who were working there since the morning (an orthopedist, Dr. Paul Pelissier and an anesthesiologist, Dr. Gabriel.
They live in the neighborhood.

Several Haitian medical students were also there to help. We quickly surveyed the place
together and assessed the supplies and meds available. Fortunately, the orphanage looked pretty well stocked, by Haitian standards, in some basic supplies and 2 American missionary nurses offered their generous help.
Some young Haitian volunteers came to help with the logistics .

When I arrived, there were about 50 patients crowding the small courtyard of the orphanage and 2 rooms converted in Pedi wards. More patients were waiting outside desperate to get in the courtyard to have some medical attention. For the next three
days we basically worked days in and days out and among other things, splinting
and casting closed fractures , reducing dislocations of limbs , setting “creative” traction systems for alignment of displaced fractures, suturing wounds, debriding infected wounds and opened fractures, watching suspicious abdomens, providing IV and PO hydrations to those who needed it, as well as pain medication (mostly oral), performing supra pubic taps for patients with pelvic fracture and bladder retention (very difficult to find a foley catheter)

The owners of the orphanage were tending to the spiritual needs of our patients and providing much needed psychological support as well as food .

Our team was, by luck, highly complementary and just after a couple of hours we
were working effectively and efficiently focusing on the goal of helping our
unfortunate brothers and sisters .

On Post earthquake Day 3 and 4 , we had to perform 2 amputations ( upper
arm and forefoot for severely infected wound and sepsis ) .Those procedures
were basically life- saving interventions for quasi gangrenous limbs. We used
some basic suture kits and some godsend hemostatic clamps and suture materials.

We had to use also some additional non surgical instruments to perform the
procedures . I went fishing for them in the toolbox of my cousin where I was
staying (saw etc…) .We make sure that all instruments used or to be used
went to a three-stage process of sterilization ( bleach solution , boiling and
bethadine bath ). We also performed two fasciotomies for compartment syndromes
( limb saving ).

The anesthetist did a very good job providing pain control
through regional blocks . Diclofenac IM worked miracle for pain control in the
postop . My surgical training and experience that preceded my dedication to
family medicine were definitely helpful in these particular circumstances

Our major surgery patients (amputees ) were free of complications on their
3rd post op day with stumps showing signs of great improvement . We discharged
them with antibiotics and instructions to report to another facility as our “clinic” was closing shop after we took care of about 100 patients .We had no death of patients who made it to our “ facility” .

On Post earthquake Day5 , I made a first trip to Leogane .We had received bad news from the area and I was especially touched by the situation .

I found the city where I grew up almost totally destroyed with limited assistance after 5 to 6 days . My colleagues Dr. Guy Craan , an Haitian MD and a Public Health specialist had talked to me over the phone and made me aware of the situation and we decided to start a care unit there jointly with a team of Haitians and Cuban doctors already in the area.

I went back to Port au Prince ( by that time I had some diesel for the vehicle I was using ) and I got a good amount of medical supplies from the UM hospital by the airport which we loaded in a pickup truck . Two haitian physicians joined our team . The post is up and
running now as a multinational care unit at the entrance of Leogane .

I left Haiti 2 days ago and I am planning to return next week .

Recommendations for medical teams:

1- The following specialties are the most needed: orthopedists, general
surgeons, anesthesiologists, family physicians and ID specialists, counselors
for emotional support, trauma and emergency care nurses, infection control
nurses.

2- Small and well balanced teams of physicians (3) and nurses(3) adjusted
to the level of care of the setting, can provide efficient care, if supplies
and proper logistics are available. It’s good to have some information on
where the teams are going and tailor the teams based on needs .

3- Some temporary hospitals will keep operating for months . After the
acute phase , there will be a need for other specialists ( internal medicine ,
pediatrics , psychiatrists , and rehab specialists ) to provide treatment for
common illnesses, follow up for post op patients and attend to the needs of the
amputees.

4- Port au Prince, Delmas, Leogane and Jacmel are places to consider.
It’s possible to piggy back on existing units of care to enhance their
ability..

Please visit our website www.amhe.org

I know Dr. BOUTIN personally! great patriot with a great philosophical mind! he does visitation on credit for many Haitians on Nostrand avenue! great guy to chat with!
a year ago, we had a great conversation about Haiti while smoking cigars!