Healing Begins in Haiti, but What's Next for Patients?

ST. MARC, Haiti (Jan. 27) -- The road to this city 60 miles outside Port-au-Prince is almost buckling under the constant stream of yellow school buses and white government shuttles with the word "Dignité" on front transporting the homeless, the ill and the wounded from surrounding areas.

Local residents and the doctors at St. Nicolas Hospital here are bracing themselves for the creation of two huge camps that will house 10,000 to 15,000 of Haiti's displaced people.

They began arriving here after the quake and are in temporary shelters until semipermanent camps can be established.

Many are like Marlene, who came from Leogane, the epicenter of the quake. When the quake struck, the 27-year-old mother was holding her 2-year-old daughter, Shaeila, in her arms. As she curled up to protect the child, the roof collapsed on top of her, breaking her pelvis. Strangers transported Marlene 90 miles to St. Marc. Her daughter survived but remains in Leogane, apart from her mom.

Emily Troutman

At St. Nicolas Hospital in St. Marc, Marlene, 27, received care for a broken pelvis. She is from Leogane, but has no plans to return there.

The doctors with Partners in Health have not been able to operate on Marlene. Partners in Health has a team of 15 at St. Nicolas. The organization had a previous relationship with the hospital, providing specialized care for tuberculosis and HIV/AIDS. But since the earthquake, the focus of PIH at the hospital has shifted to providing urgent care, such as surgery, and especially orthopedic operations. A new team of eight nurses, four surgeons and three anesthesiologists have treated 600 patients in two weeks.

Pelvic surgeries, like the one Marlene needs, are not being treated at the hospital because doctors here lack the complex supplies and equipment necessary, including X-ray capacity, blood transfusions and plates to repair the bone. As a result, Marlene is unable to walk and spends her days in bed, being treated for pain and taken care of by her sister, Juliene.

Emily Troutman

Kedgaidi, 12, just underwent surgery for a broken leg, nearly two weeks after the earthquake. If he is able to receive crutches and heal properly, doctors expect him to recover in eight weeks.

Two weeks after the quake, Dr. Stephen Lockhart, leader of the surgical team at St. Nicolas, says many people are still coming in for simple orthopedic surgeries, mostly because they had been afraid to receive care. "In the beginning, there were a lot of amputations, so people were scared that if they broke something, that meant they were going to have a limb removed," he said.

Doctors at St. Nicolas universally say that they have the adequate medicine and equipment necessary to provide a sufficient and ethical "standard of care" for most cases. Two patients needing complex surgeries were recently flown by helicopter to the USNS Comfort, off the coast of Port-au-Prince. But the hospital is still desperate for nurses with trauma- or wound-care experience.

Emily Troutman

St. Nicolas Hospital in Saint Marc, Haiti, is 60 miles from Port-au-Prince, and though post-earthquake surgeries have slowed, care continues for the disabled.

"It's easier, I guess, for surgeons to volunteer their time, so maybe that's why we have a nursing shortage," said Sarah Marsh, liaison for Partners in Health at St. Nicolas. Many patients are suffering from wounds or physical injuries that require intensive nursing support to avoid infection.

It will grow increasingly difficult for St. Nicolas to provide adequate ongoing care because the hospital has not figured out how to deliver services like physical therapy to disabled patients who are also homeless.

Emily Troutman

Doctors with Partners in Health deliberate on how best to utilize the limited space at St. Nicolas to treat patients.

The hospital has no wheelchairs or crutches to give patients when they leave. One doctor admitted, "I gave away one of the hospital's wheelchairs today ... which I don't even know if we're allowed to do. I'm sure we're not. But I did it."

Lockhart said, his voice filling with remorse, "You have to wonder how Haiti is going to deal with paraplegic people, people missing limbs, people who can't walk but don't have wheelchairs."

The biggest challenge for these doctors is sending patients "home." None of the doctors at St. Nicolas has seen where their patients go when they leave the hospital. But all over St. Marc, small outpatient camps for the displaced have emerged at local ministries and in empty lots.

Emily Troutman

About 80 homeless and injured Haitians are now living at Youth with a Mission ministry in St. Marc.

Ministries, just like hospitals, have been shifting their focus to urgent needs. Before the earthquake, Youth With a Mission, an organization out of Kona, Hawaii, said on its Web site, "This area, known as the 5th section, is the heartland of much of St. Marc's voodoo -- but won't be for long! During this new year we have made significant advances ... Many are starting to cast out all of their voodoo!"

On one recent day, Audrey Martin, a young woman operating one of the camps, looked more like an overwhelmed emergency room nurse than an evangelist set to cast out voodoo. St. Nicolas has sent about 80 patients to the mission, where they receive basic medical attention and food, and sleep under the large roof of an outdoor amphitheater.

Youth With a Mission will transfer the patients and families on their property to one of the new public camps for internally displaced people being established in St. Marc, as soon as preparations to build them are complete.

Emily Troutman

At Youth with a Mission ministry, people with injured limbs take turns using crutches and wheelchairs.

The mission was assigned the responsibility of installing plumbing and electricity at the site of one of the new camps, but Martin could not give an estimate of when the staff will finish that work, "Soon, we hope," she said. "We need this space for our volunteers who are coming."

Two buses of missionaries and volunteers streamed into Saint Marc that same afternoon.

In the meantime, patients like Marlene face an uncertain future. Her pelvic injury will likely keep her bedridden and unstable for weeks. Tuesday, she was offered a chance to go by helicopter to the USNS Comfort, in order to receive the much needed reconstructive surgery to her pelvis. Surprisingly, Marlene refused to go because the ship does not allow family members to go with patients, and she was unwilling to leave behind her sister, Juliene.

Emily Troutman

This space, an amphitheater in Saint Marc, will soon be filled with Youth with a Mission volunteers, and the Haitian residents will be transferred to camps.

Today, the USNS Comfort announced they are no longer taking patients with pelvic injuries, due to the high demand for this surgery and their limited surgical capacity. It is unknown whether or not the ship will eventually resume this treatment.

For now, Juliene will stay with Marlene to care for her in their small space on the floor of Saint Nicolas Hospital. After that, they don't know where they will go, but it won't be back to Leogane.

"My life is not up to me," Marlene said.

Emily Troutman

Two buses of volunteers stream into Saint Marc, all arriving from the U.S. Many will help build the plumbing and infrastructure necessary to stand up two massive refugee camps in the city.