Giuseppe
Emeritus
The GHESKIO Field Hospital and Clinics after the Earthquake in Haiti -- Dispatch 3 from Port-au-Prince (N Engl J Med., extract, edited)
Published at www.nejm.org February 17, 2010 (10.1056/NEJMpv1001787)
The GHESKIO Field Hospital and Clinics after the Earthquake in Haiti ? Dispatch 3 from Port-au-Prince
After the January 12 earthquake in Haiti, the Port-au-Prince clinic of the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO) became a refugee camp and an emergency field hospital (see slide show), in addition to remaining a clinic for patients with AIDS or tuberculosis. Our field hospital was established 7 days after the earthquake, with the arrival of a surgical team from the U.S. Department of Health and Human Services (DHHS). During the past 4 weeks, the 80-member DHHS team has seen more than 2500 patients, 40% of them less than 18 years of age. The surgeons have performed 278 major surgeries; the most common included placement of external fixators to stabilize fractures, d?bridement of necrotizing soft-tissue infections, and lifesaving amputations. The hospital is now seeing mostly minor surgical cases and infectious diseases. Patients with the most complicated cases have been stabilized and evacuated by helicopter to the U.S.N.S. Comfort, a 500-bed naval hospital ship in Port-au-Prince Bay.
Tetanus is a major problem; tetanus vaccines were in short supply after the earthquake, and many Haitians are not vaccinated. So far, we have seen two children and one adult with advanced tetanus. One died, one is recovering, and one was evacuated to the U.S.N.S. Comfort.
A looming question is what happens to disabled patients in need of additional operations and rehabilitation when the international medical teams depart. The Haitian medical system in Port-au-Prince has been devastated and is not prepared to handle the tens of thousands of patients with amputations, paralysis, or major fractures who will need months or years of care. GHESKIO is opening a rehabilitation center; international rehabilitation experts are assessing the needs, we are securing supplies, and we will train Haitian occupational and rehabilitation therapists.
Children are now presenting with diarrhea, febrile illnesses, respiratory tract infections, and scabies superinfected with staphylococcus and streptococcus. Before the earthquake, Haiti had one of the world's highest levels of food insecurity. Childhood malnutrition is now a worsening problem; mothers have no food, pots, or cooking fuel. Children who were chronically malnourished before the earthquake are becoming severely malnourished. Children who were severely malnourished before the earthquake are dying. Many infants were separated from their injured mothers and abruptly weaned from breastfeeding. These babies are not receiving adequate feeding and hydration; they are presenting to the field hospital in critical condition, with severe dehydration.
GHESKIO has established an emergency nutrition program for refugees and patients. We are providing supplementary feeding for children less than 5 years of age and pregnant women, conducting surveillance and rehabilitation for severe malnutrition, promoting exclusive breast-feeding, and providing replacement feeding for babies without mothers.
(...)
[See full free document at the link showed below]
<cite cite="http://content.nejm.org/cgi/content/full/NEJMpv1001787?query=TOC">NEJM -- The GHESKIO Field Hospital and Clinics after the Earthquake in Haiti -- Dispatch 3 from Port-au-Prince</cite>The GHESKIO Field Hospital and Clinics after the Earthquake in Haiti ? Dispatch 3 from Port-au-Prince
After the January 12 earthquake in Haiti, the Port-au-Prince clinic of the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO) became a refugee camp and an emergency field hospital (see slide show), in addition to remaining a clinic for patients with AIDS or tuberculosis. Our field hospital was established 7 days after the earthquake, with the arrival of a surgical team from the U.S. Department of Health and Human Services (DHHS). During the past 4 weeks, the 80-member DHHS team has seen more than 2500 patients, 40% of them less than 18 years of age. The surgeons have performed 278 major surgeries; the most common included placement of external fixators to stabilize fractures, d?bridement of necrotizing soft-tissue infections, and lifesaving amputations. The hospital is now seeing mostly minor surgical cases and infectious diseases. Patients with the most complicated cases have been stabilized and evacuated by helicopter to the U.S.N.S. Comfort, a 500-bed naval hospital ship in Port-au-Prince Bay.
Tetanus is a major problem; tetanus vaccines were in short supply after the earthquake, and many Haitians are not vaccinated. So far, we have seen two children and one adult with advanced tetanus. One died, one is recovering, and one was evacuated to the U.S.N.S. Comfort.
A looming question is what happens to disabled patients in need of additional operations and rehabilitation when the international medical teams depart. The Haitian medical system in Port-au-Prince has been devastated and is not prepared to handle the tens of thousands of patients with amputations, paralysis, or major fractures who will need months or years of care. GHESKIO is opening a rehabilitation center; international rehabilitation experts are assessing the needs, we are securing supplies, and we will train Haitian occupational and rehabilitation therapists.
Children are now presenting with diarrhea, febrile illnesses, respiratory tract infections, and scabies superinfected with staphylococcus and streptococcus. Before the earthquake, Haiti had one of the world's highest levels of food insecurity. Childhood malnutrition is now a worsening problem; mothers have no food, pots, or cooking fuel. Children who were chronically malnourished before the earthquake are becoming severely malnourished. Children who were severely malnourished before the earthquake are dying. Many infants were separated from their injured mothers and abruptly weaned from breastfeeding. These babies are not receiving adequate feeding and hydration; they are presenting to the field hospital in critical condition, with severe dehydration.
GHESKIO has established an emergency nutrition program for refugees and patients. We are providing supplementary feeding for children less than 5 years of age and pregnant women, conducting surveillance and rehabilitation for severe malnutrition, promoting exclusive breast-feeding, and providing replacement feeding for babies without mothers.
(...)
[See full free document at the link showed below]