JAN 22: MEDICAL CRISIS IN HAITI

The following is an article from Medscape Medical News on JAN 22:
40 HEALTH FACILITIES, 24 OPERATING THEATRES FUNCTIONING IN HAITI
The number of functioning healthcare facilities has increased to 40, and the number of field hospitals with operating theatres is now at 8 in Port-au-Prince, Haiti, Dr. Jon Kim Andrus, deputy director of the Pan American Health Organization (PAHO), reported during a briefing this morning.

Meanwhile, Partners in Health (PIH) reports it has established 24 operating rooms, and more than 140 surgeons, nurses, anesthetists, and other specialists are working around the clock at sites in and around Haiti.

However, just as the delivery of supplies was increasing, large aftershocks again rocked the country early this morning, partially destabilizing the docks that have only just begun to reopen in Port-au-Prince's harbor after the original 7.0-magnitude quake completely disabled it on January 12.

The primary medical problems are currently orthopedic in nature. The risk for serious wound infections is now beginning to increase, as is the threat of emerging infectious diseases.

"It is fractures, fractures, fractures," said World Health Organization (WHO) Representative Henriette Chamouillet, MD, in a videotaped message, "and that means a lot of orthopedic surgeons, and a lot, a lot of material, a lot of dressings."

The naval hospital USNS Comfort received about 240 patients in the first 36 hours in dock, said commanding officer Captain James Ware.

Médicins sans Frontièrs (MSF, Doctors Without Borders) reports that it has treated nearly 1000 patients in its surgical facilities. Physicians are seeing "increasing numbers of patients with renal failure receiving life-saving dialysis, [and] there is already a significant need for specialist and sometimes long-term care, such as physiotherapy and psychological support.... Aftercare will soon become very demanding, and MSF is starting to organize postoperative care units," MSF said in a news release.

"When you have so many injured people with deep wounds, open fractures, and crushed limbs, the more and the faster you can proceed, the better it is," explained Xavier Lassalle, one of MSF's specialist medical advisors. "But providing for these surgical and medical needs will take months, and usually many of these emergency surgical teams stay no more than a few weeks.

Dr. Lassalle continued, "Most of the wounded have infected wounds in their limbs, and they will have to undergo several cleaning operations in theatre, and then often orthopedic and reconstructive surgery. This requires postoperative care for several weeks."

The Global Health Cluster of the WHO and PAHO have identified 5 urgent health concerns:

Coordination of healthcare and ongoing needs assessment;
- Prevention and control of actual and potential infectious disease outbreaks, with ongoing assessment;
- Provision of safe water for healthcare facilities and ongoing monitoring of water quality;
- Availability of essential drugs and medical supplies; and
- Restoration of basic healthcare services to care for ongoing health issues, such as HIV, cancer, diabetes, and other chronic illnesses.

"We are coordinating an extraordinary health response, with donor countries, [nongovernmental organizations], and the [United Nations]. Done correctly, this will help Haiti save lives today and build a stronger health system for the future," the WHO said in a statement today.

Dr. Andrus reiterated these concerns, saying "there is a significant risk of infectious disease, especially water-borne diseases. We need a sustained supply of clean water.... The threat of dehydration and malnutrition [is increasing], especially in the very young, in pregnant and lactating women, and in the very old."

"It is critical to promote breast-feeding now," Dr. Andrus pointed out, particularly because clean water is in such short supply, as is infant formula.

Dr. Andrus also noted that the data show that approximately one third of women are abused, including sexually. "Women are not getting the services they need," he asserted.

Large quantities of medications, baby formula, and other relief supplies are sitting on the tarmac and in warehouses at the Port-au-Prince airport, but no one is moving it out, according to a report from CNN.

At least 72,000 people have been confirmed dead in the quake, according to Prime Minister Jean-Max Bellerive.

The American Red Cross is shipping in blood donations. UNICEF and PAHO are working on sanitation and setting up and maintaining latrines.

Despite the critical healthcare needs, WHO Assistant Director General, Health Action in Crises, Eric Laroche, MD, urged caution for healthcare providers wishing to aid in the relief effort. "There has been an extraordinary response to such a small location that there is a danger of creating more chaos.... Coordinating care is our top priority," he said.