Team leader Christian Theodosis, MD, sent this description of a patient who recently arrived at the medical relief camp at Fond Parisien.
Three weeks ago a 23-year-old woman sustained profound injuries to her left arm and leg during the earthquake in Port-au-Prince. Unable to get medical attention in the city, she traveled overland seeking care. After three weeks, she ultimately managed to make it all the way to Baharona, a four-hour drive into the Dominican Republic--about 60 miles east of the Haitian border.
When she arrived in Baharona, her wounds had not yet been treated. She had severe crush injuries, complicated by swelling that restricted blood flow. The breakdown of damaged muscle in her arm and leg released fibers into her bloodstream. That led to kidney damage, and eventually acute renal failure. In Baharona, a surgical team performed fasciotomies, cutting open the fibrous tissues that surrounded the injured areas to reduce the internal pressures. But the team there had no way to provide the necessary post-operative care and sent her in search of our medical relief camp. Word of our field hospital is spreading.
She arrived here late last night with her family. She was barely conscious, with dangerously low blood pressure, heart rate and blood-oxygen levels. The skin was missing from much of her left arm down to the middle of her hand and her leg remained swollen with poor blood flow, despite her surgery. On the bright side, her urine was clear, evidence of kidney recovery. With intensive treatment, we were able to restore her hemodynamics and keep her alive through the night. This gave us time to arrange helicopter transport to the Navy's hospital ship, the Comfort, which is off the coast of Port-au-Prince and offers surgical services and tools that are not otherwise available in the region right now.
A few moments ago, we heard the rumble of military helicopters landing at the camp. Dr Haydon and I escorted the patient to her flight. So, after her long and difficult journey from Port-au-Prince to Baharona, in the Dominican Republic, back to Haiti and Fond Parisien and now full circle to the waters off Port-au-Prince, one terribly injured patient who had survived long travel and terrible conditions, finally made it to definitive care. These are the cases that remind us why we are here.
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