The Jan. 12 earthquake that flattened much of Port au Prince, Haiti, and killed at least 230,000 people is providing valuable lessons for disaster preparedness and response on an almost unimaginable scale, says Scripps Health CEO/President Chris Van Gorder.
"There were two reasons why we went down there," says Van Gorder, who recently returned from his second trip to the stricken nation since the earthquake. "The first was humanitarian. The second was the learning. I am passionate about disaster planning and I don't believe the time to learn how to function in a disaster is when the disaster occurs."
Van Gorder concedes that it's doubtful that the United States will experience a natural disaster of similar magnitude because of building codes, infrastructure, engineering, and planning. The Haitian earthquake and the 1989 earthquake that struck the San Francisco Bay area both measured around 7.0 on the Richter Scale. The San Francisco quake claimed 63 lives. Even Hurricane Katrina, with more than 1,800 fatalities, pales in comparison to the death toll in Haiti.
Regardless, Van Gorder says providing care in the most challenging of environments is giving U.S. healthcare professionals valuable experience that can't be replicated by disaster training drills.
"We saw the injuries that would occur in an earthquake—major extremity injuries, major crush injuries, amputations, spinal cord injuries, pressure ulcers caused by people being underground and in the same position for extended periods of time," Van Gorder says.
The Scripps response team and a University of Maryland medical team worked in the remains of the Hospital St. Francois de Sales. It was grim, desperate work under bad conditions.
"Half the hospital collapsed, a four-story building which was their pediatric unit. The estimate was somewhere between 50 and 200 bodies were still entombed in the building," Van Gorder says. "We went into some areas of the hospital that hadn't collapsed, but were adjacent to the building and the smell was atrocious. Our CMO said he almost threw up, and he has been dealing with trauma his entire career."
Even in those hellish conditions, Van Gorder says he was inspired by the extraordinary flexibility and creativity of doctors and nurses.
"They created as sterile an environment as possible without the tools we have here. Our scrub sink was a bucket outside. We saw a rip saw that was being sterilized for amputations. Fortunately we didn't have to use it."
"We were doing our anesthesia on the first trip with ketamine. There was no general anesthesia. There was no intubating the patients during surgery," he says. "A nurse anesthetist gave them a shot and disappeared. I was responsible for monitoring the patients' vitals while the surgeon did surgery and I was a scrub nurse. It wasn't Civil War medicine, but it was more like World War I medicine."
When the Scripps team returned to Haiti with more medical supplies, Van Gorder says they could administer pain medications and general anesthesia.
"Instead of going directly to amputations, we were trying to save limbs," he says. "But we had one woman who died of pneumonia and congestive heart failure. There was no technology there to save her. She died outside under a tent. It was the best we could do under the circumstances."
Van Gorder says the road to recovery for Haiti will be long. Non-governmental organizations that are trying to provide care and other assistance must understand that the Haitian government has essentially ceased to exist.
"The Health Ministry completely collapsed with many of the leaders of healthcare in Haiti killed within the building. The Supreme Court was killed in session. The palace has been destroyed," Van Gorder says.
"The question is what happens from here? It's a poor country that imports everything and exports little if anything. They had a hard time feeding and educating their population before this. Look at the destruction, both in the public and private infrastructure, and you wonder where the money is going to come from to rebuild. I often wonder how long countries and hospitals will have the appetite to continue to work in Haiti. It's not month, we are talking years before they can recover."
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.