Correction Appended
Battling patients' sepsis, tetanus and renal failure, the Dartmouth Haiti Response emergency medical teams fought to deliver care in conditions "worse than Iraq," team members said in a panel discussion held in Cook Auditorium on Friday.
A total of 20 physicians and nurses from Dartmouth-Hitchcock Medical Center traveled to Haiti to assist in relief efforts in Hinche and Port-au-Prince, Haiti, following the Jan. 12 earthquake that devastated the region.
A lack of electricity and access to modern medical technology constrained the services the teams could provide, often limiting them to only "basic rudimentary care," according to Jim Geiling, a Dartmouth Medical School professor and director of the intensive care unit at the Veterans Affairs Medical Center in White River Junction, Vt.
"It was, in some ways, Civil War medicine just clean water and bandages," he said.
The teams needed to assess conditions and adapt to situations quickly to save the greatest number of lives, according to Rachel Allen, a nurse on the second team, which went to Port-Au-Prince.
"We essentially entered a situation where everyone was a MacGyver," she said.
The teams lacked blood pressure cuffs, had no means of monitoring vital signs or performing cultures and could only perform simple X-rays for a few hours of the day, DHMC trauma program director Rajan Gupta said.
Because Hinche is not connected to the electrical grid, medical teams had to rely on generators for power, he said.
Gupta, who led the first team sent to Haiti, echoed the difficulties of working in an environment with limited access to medical technology.
"It was a gloomy environment," he said. "There were only one or two light bulbs in the ward. We made rounds [at night] with headlamps."
Both teams saw an overwhelming number of external injuries in addition to crush syndrome, according to DHMC nephrology and hypertension specialist Brian Remillard, who led the third team.
Victims of accidents like earthquakes often suffer from crush syndrome, an ailment in which muscles are damaged by crush injuries and cause shock when the pressure is released and blood begins flowing through the damaged tissue.
Dehydration and sepsis contributed to cases of kidney failure, and patients required dialysis as a result, Remillard said.
The teams also struggled with accepting the reality of high mortality rates in the aftermath of the earthquake, Gupta said.
Physicians and nurses, suffering from limited resources and time, had to make "hard decisions" about who would receive care, Allen said.
"It was the worst kind of triage," she said. "You had to find people who you knew you could probably save."
Yet in the midst of the chaos in Hinche, Gupta said he saw that "life goes on."
"Babies were being delivered, C-sections were being performed we needed to support the daily care in Haiti as well," Gupta said.
Gupta said that his team aimed to cooperate with other medical providers in Hinche, focusing on developing relationships and trust with local organizations to ensure a collaborative effort.
"We tried to create concepts, products and services that could be sustainable after we were gone," Gupta said. "Education is going to be vital in the long-term support of these people."
None of Haiti's medical schools survived the earthquake, Remillard said.
Remillard suggested setting up lectures for medical students as a "simple goal" of preserving a sense of continuity for those in Haiti.
Working with the existing Partners In Health infrastructure in Haiti made Dartmouth's medical response possible, according to DHMC Executive Director John Butterly, who moderated the panel.
"Haiti was a disaster before this disaster," Butterly said. "We absolutely intend to responsibly and sustainably develop a relationship between the Dartmouth community and the people of Haiti."
The medical teams sent to Haiti are only one part of Dartmouth's Haiti Response, both Butterly and Geiling said.
"We had a great opportunity to do a terrific mission and we touched a lot of lives," Geiling said. "But there was a whole group of people back here that made this possible."
Students at Dartmouth for Haiti Relief has raised over $180,000 in donations to PIH, the nonprofit global-health organization College President Jim Yong Kim co-founded.
The presence of DHMC employees in Haiti did not compromise the care provided at the medical center, Butterly said.
"We need to thank the people that stayed behind to make sure that [DHMC] maintained our primary purpose, which is to deliver care to the people in this region," Butterly said.
