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CMAT (NGO) in Haiti

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Nurse worried over conditions in Haiti
19 January 2010

LEOGANE, Haiti — Canadian nurse Sandra Hodge came to Haiti to save lives but in her first few days here she has watched three people die before her eyes.

And she worries those she can help won’t get a fighting chance as they recuperate from surgery in the street.

Hodge, who is from Jasper, B.C., arrived in Haiti five days ago, volunteering at the overwhelming packed Hopital Universitaire de la Paix before joining the Canadian Medical Assistance Team’s field hospital in Leogane.

Medics are trying to treat as many of the injured as they can, rotating people quickly after amputations but forcing them outside to clear more room.

“People end up outside in no homes and have no water, they are not being hydrated and are malnourished, they just had a surgery and they are lying in the street and their wounds become increasingly infected. It’s just an ongoing cycle,” she said.

The hard part is knowing that in many cases, without adequate equipment, X-rays and MRIs, there is little foreign medics can do, she said.

Hodge explained how a man leaking spinal fluid from his head complained only of a headache. His wife sat next to him singing hymns while he died.

Hodge said she is impressed by how stoic the Haitians are.

“A man had a femur fractured for five days. I repositioned it and casted it — without all the casting material needed — and he just sat there and smiled at me throughout the whole thing, in incredible pain ... It’s pretty amazing,” she said.


Canadian-run field hospital in Haiti faces hard reality of quake victims
Sheldon Alberts, Canwest News Service
21 January 2010

LEOGANE, Haiti -- The injured arrive on crutches and on stretchers, or cradled in the arms of distraught mothers. On a sun-baked soccer field turned Canadian field hospital, each new patient seems to present wounds more heartbreaking and severe than the one before.

Under a white canvas stretched between two military tents, nurse practitioner Carolyn Davies removes several maggots that have infested a gash on Therese Fleurant's foot. In the adjacent surgical tent, Vancouver doctor Donna Smith amputates a 16-year old girl's toe as she lies on a stretcher set upon a stack of cinder blocks.

Only a metre away, another amputation. British Columbia doctor Ray Markham is removing the right pinky finger of a young woman, whose blood drips into a pool on the canvas floor.

The conditions for treatment here would be considered raw and challenging by any standard, but they are made immeasurably more intense because the earth is rumbling from two aftershocks that occur even as the doctors do their work.

"This is tough. Lots of kids," says Bill Coultart, a paramedic from Comox, B.C.

He is one of 16 members of the Canadian Medical Assistance Team who have deployed to Leogane, a city of 130,000 people and mounds of rubble about 30 kilometres west of Port-au-Prince.

"I had a kid come in about an hour ago with a plate-sized hole in his head right down to his skull," says Coultart. "It's infected. Whether he'll survive that, I don't know. We do what we can."

The first members of the Ontario-based NGO arrived in Haiti two days after the Jan. 12 earthquake destroyed or damaged about 80% of Leogane's buildings.

By Tuesday night, with help of a contingent of Canadian sailors from HMCS Athabaskan, they had erected a hospital that by Thursday had already received several hundred patients.

Nine days after the Jan. 12 earthquake, infections and gangrene have become so widespread among victims -- particularly those with crush injuries -- that doctors fear they will have to perform dozens of amputations in the coming days and weeks.

"We can work all night if we could. There's that many people," says Smith, who practices medicine at St. Paul's hospital in Vancouver.

"In Haiti, if you are badly infected down to the bone, it basically means you have to get an amputation."

Smith's 16-year-old patient showed up at the Canadian clinic only on Thursday morning, and quickly resigned herself to losing her toe. It was the best of several bad options.

"The toe was dead -- she basically had gangrene. But at least we only had to take her toe, not her leg," says Smith. "The patients understand the crisis situation. They live in it every day. This is just that much worse."

The situation in Leogane -- as in remote communities across the earthquake zone -- is "only going to get worse" unless more help arrives soon, Smith says.

In Ottawa, Defense Minister Peter MacKay said that more help is coming. The Canadian Forces are deploying a military-field hospital to the city, staffed by 100 doctors, dentists, surgeons and support staff. The hospital will be equipped with an operating room, lab facilities and 50 minimum care beds.

"There is not a lot of infrastructure here. These people are the poorest of the poor, and now they are even poorer. So they need as much care as they can get," said Valerie Rzepka, a 33-year-old Toronto nurse who serves as CMAT's chairwoman.

Although the conditions are primitive, the medical care is not.

The Canadian field hospital doesn't include a proper operating room because it lacks equipment to provide patients with general anesthetics. But the area is sterile, and Dr. Kate Bennett, a 34-year-old Vancouver physician can provide full spinal anesthesia.

For lower leg amputations, she can selectively block nerves at the ankle. For lower arm amputation, Bennett can block nerves at a patient's neck. So while they are awake during amputation, they are not in pain.

"It's really first-world treatment in getting those amputations done in a safe and pain-free manner," says Bennett.

Many patients are too severely infected when they arrive here to avoid amputation. But some are luckier -- like Fleurant, with her crushed foot.

The wound was poorly bandaged immediately following the earthquake and became a perfect environment for maggots. But it was not yet infected when Davies cleaned the wound on Thursday.

"If there's bone involvement, then there's not much chance," Davies says. "But she is a little lucky. She has a good chance of keeping the leg."

Only two days into an extended assignment in Leogane, the volunteer doctors and nurses must also worry about fatigue.

"We start at eight o'clock in the morning and we go until eight o'clock at night. It's pretty much steady. You try to get a break when you can," said Aric Rankin, a registered nurse from London, Ont.

Many of the Canadian doctors and nurses here have past experience in responding to massive natural disasters; several are veterans of the Asian tsunami, the Kashmir earthquake and the Bangladeshi cyclone.

But that doesn't protect them from being affected by the scope of the tragedy -- and there are moments when the trauma they see becomes overwhelming.

"The most profound thing that affects us is the aromas. It's better here than it is in Port-au-Prince," says Rzepka. "You get the smell of death, but now we are also getting the smell of infections. That's just as bad if not worse. But I'm holding up."

Amid the parade of walking wounded into the Canadian hospital, there has been one tiny miracle. A pregnant woman at full-term reported with an obstetric emergency, telling doctors that she had not felt her baby kick for two days. The medical team expected they would deliver a stillborn -- instead the baby was delivered alive and kicking.

"He came out crying and happy," says Rzepka. "That cheered everybody up."


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Kathryn Blaze Carlson in Haiti: This 'should be the future of Canadian disaster relief'
Posted: February 03, 2010, 7:57 PM by Ron Nurwisah

National Post reporter Kathryn Blaze Carlson and photographer Tyler Anderson are currently in Haiti with members of the Canadian navy aiding with the reconstruction of that country. They will be filing dispatches in the coming days:

Feb. 3, 7.25 p.m.: On either side of the Canadian Medical Assistance Team's field hospital in central Leogane, are two crumbled schools. The total number of dead still among the rubble, I am told, is estimated at 35.

But in a green field between the death and destruction, is a glimpse of progress.

There, the CMAT staff, supported by Canadian soldiers and sailors, treat patient after patient in a pop-up operating room.

However, today, after weeks of long of long days and long lines, the field hospital was quiet. Its doctors, and there are three of them, were down for the day with a bout of heat exhaustion, some feeling generally overwhelmed.

Still, treatment and triage did not cease, as improvisation saved the field hospital from complete shut-down.

Petty Officer Second Class Stephen Blois, a 41-year-old father of two, was among those who manned the X-Ray machine while doctors and nurses recovered under their tents.

"The staff showed me how to use the machine, and I got to work," Officer Blois said, adding that doctors emerged to read the films. "I X-Rayed a little girl's head and leg, and it turned out she need her cast changed. I carried her to a bath and soaked the cast, then used my navy knife to remove it."

To be sure, this is not a typical day in the life of a sailor. But then, not much of OP HESTIA is. For most sailors, this is their first humanitarian operation.

"Usually we stay at sea, and don't come ashore," Officer Blois said. "It's a good experience for our guys to see how the army guys live and work."

CMAT's orthopedic surgeon said he and his team are indebted for the on-the-ground partnership with the Canadian Forces -- without the security, for one, he fears the team's efforts would have been paralyzed by looters.

"We're living in a little tent-city of our own, and we need protection," Dr. Kostomo said. "This sort of cooperation should be the future of Canadian disaster relief."


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Halifax-based medical officer, Captain Ron Stecum, assists Dr. Donna Smith, a volunteer surgeon with Canadian Medical Assistant Teams, with surgery to amputate an earthquake victim’s hand in Leogane, Haiti.