John Brebbia: Surgeon's Work Honors Fallen Friend

"In the face of such a huge and overwhelming tragedy I saw people who really acted in a decent manner."

In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is John Brebbia's story.

For trauma surgeon John Brebbia, MD, volunteer work in Haiti after the Jan. 12 earthquake was inspired by the memory of a fallen colleague, as much as it was by the knowledge that the practical expertise and care he could provide was desperately needed in the stricken island nation.

"I had a good friend who really would do this kind of thing on a fairly regular basis. That included him joining the military to be a doctor in Iraq," Brebbia says of U.S. Army Maj. John P. Pryor, MD. "Unfortunately, John was killed by a mortar on Christmas Day 2008. I know that if he had still been alive he would have gone to Haiti. Since he was not alive, that space was not filled. I know he would have been on me to go, go, go, and as a tribute to him I went."

Brebbia, of Dover, DE, became one of the thousands of healthcare professionals who travelled to Haiti in the days immediately after the quake.

The United Nations estimates that between 250,000 and 300,000 people were killed by the 7.0 magnitude temblor, although no firm number has been established. Hundreds of thousands more suffered from traumatic injuries as well as illnesses  resulting from the ensuing breakdown in public sanitation.

Brebbia was part of a 22-member team of healthcare professionals affiliated with Christiana Care and Bay Health Medical Center in Delaware that travelled to the flattened hillside city of Jacmel, 90 miles south of Port au Prince, eight days after the quake.

"It is an unbelievable, overwhelming sight. You can see the pictures but you cannot even fathom it until you are standing there looking at it," Brebbia says. "Jacmel is built on a hillside. You stand at the foot of the hill and everything is in rubble and there are people living in the streets. More than one person, when they stood there and looked at it, cried because of what they saw."

Soon enough, however, the needs on the ground overtook the shock as the team scurried to provide care in the ruins. "There was one building we thought we were going to use the first day we got there. When we came back the next day to set it up, it had come down in one of the aftershocks," Brebbia says.

With all of the hospitals either flattened or wobbling and unsafe, Brebbia and his colleagues got tents, diesel fuel, and other critical supplies from members of the Canadian army—who also commandeered a generator from the office of a reluctant hospital administrator—and began work. "I would say we worked between 16 and 20 hours a day depending upon the day," Brebbia says, adding that he performed about 30 operations requiring anesthesia during his eight-day mission, and treated hundreds of other patients for wounds and ailments.

As expected, the surgeries for Brebbia often involved amputations of limbs crushed in the falling debris. "Probably the worst one I saw was a 3-year-old whose leg I had to take off. Her leg was totally crushed just above the ankle. I took it off just below the knee," he said. For many of the amputations, Brebbia used an old-fashioned gigli saw because the rescue team wasn't sure if they'd have access to electrical power. With the generator, Brebbia's team powered an autoclave plucked from the rubble of a hospital. "Initially we thought we were gong to have to use and throw away, but the Canadian Army really helped us," he says.

Even with the tremendous sense of mission for the work at hand, Brebbia says the trip was fraught with "huge frustrations."

"Things could have been done better. When we first arrived in Jacmel the mayor said none of us could work because he couldn't verify who we were. They didn't have a plan to verify who we were and they weren't going to let us work," Brebbia says.

Fortunately, a member of the Delaware rescue team was a Jacmel native who had been instrumental in planning the mission. "She got on the mayor pretty good to the point where he just said, 'I will take her word that you are all OK,'" Brebbia says. "Then we went to the hospital and the administrator didn't want us working in his hospital, which was a pile of rubble. There were tents outside. Well, not even tents. They were tarps over trees and patients under the tarps in the open air. The nurses were family members. If you didn't have a family member, you didn't have a nurse."

Fortunately, the Canadian army did a remarkable job maintaining order. "We would call them and say we need diesel fuel and 10 minutes later there is a 40 gallon drum of diesel fuel," he says. 

The Canadians also handed out food, tents, and clothing on a massive scale to all parts of the city. "It prevented the people there from becoming unhappy, disgruntled, and dangerous," Brebbia says. "In Port au Prince we saw people killing each other for food. In Southern Haiti that didn't happen because of the way and the speed that the Canadians dispersed the aid was so great that people where having their basic needs met. We never felt threatened. We never felt unsafe."

Now back in Delaware, Brebbia thinks often of Haiti and the huge obstacles the nation still faces as it struggles to recover.

The time he spent there has changed him. "It's impossible not to," he says. And despite witnessing some decidedly dire images, he saw much good that stay with him.   "Personally speaking, I saw hundreds of people whose lives were devastated—parents who lost little kids and who despite that were able to treat their neighbor better, or they took in kids who didn't have parents."

"In the face of such a huge and overwhelming tragedy I saw people who really acted in a decent manner. It does make you at least want to try to treat your neighbors better," he says. "Because if these people can do it in the face of that, why can't we do it every day?"