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Devastation in Haiti

Saving lives with just the tools at hand

No water, no power as surgical mission starts in on the endless line of need

By Maria Sacchetti
Globe Staff / January 17, 2010

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PORT-AU-PRINCE, Haiti - “That’s it? Nothing more?’’ Dr. Mark Hyman, a physician from Lenox, Mass., asked a group of aid workers at Haiti’s largest hospital yesterday, holding up a small jug of alcohol as a badly injured woman lay on the operating table behind him.

“Do you have vodka? Drinking alcohol?’’ he said, seeking anything antiseptic. “Maybe somebody could go find some?’’

“Are you kidding?’’ a translator replied.

He was not.

Haiti’s General Hospital, crippled by Tuesday’s earthquake, had only a skeleton staff of volunteers, dwindling supplies, and a makeshift operating room that sprang into action yesterday for the first time since the devastating 7.0-magnitude quake.

A small team of surgeons, a nurse, and an anesthesiologist from Massachusetts, Florida, and California had no electricity, no water, and only a hacksaw to remove part of a woman’s leg. They had flown in the day before and grabbed three hours’ sleep on the operating room floor.

This first surgery was a test to see how an operation would work under extreme conditions, and whether they could begin to help the incomprehensibly long line of people who filled the 700-plus bed hospital’s darkened wards and spilled into the courtyard outside in a caravan of sheet-covered gurneys. The operation took place in a cavernous white room that held supplies the Americans had brought with them.

“I need to find a bucket, a flat basin,’’ said Hyman’s wife, Pier Boutin, an orthopedic surgeon at Fairview Hospital in Great Barrington, Mass.

She looked expectantly at bystanders. They stared back. She searched the room herself, aided by her husband, and finally decided to dispose of the medical waste in a red garbage bucket.

“It was harder to look at it on TV than to be here and do something about it,’’ Boutin said. “There are so many. We’re just going to do one at a time.’’

In the courtyard, aid workers and physicians from International Medical Corps, a humanitarian aid organization, made lists in notebooks of those who would receive care. In the United States, the most urgent cases soar to the top of the list. But here, complex surgeries are impossible for now, so they began with a simple case of a woman who had lost her foot, and needed a partial amputation to create a stump.

Boutin, a 48-year-old mother of four, performed the operation with her father, Georges Boutin, also an orthopedic surgeon, who came from Fort Lauderdale, Fla., a 73-year-old with a head of gray hair who runs 5 miles a day. Hyman, a nurse, and an anesthesiologist assisted.

If they could pull off one operation, they could help others.

Reminders of the life-or-death stakes were everywhere. The stench of death from the nearby morgue hung in the air. Hundreds of bodies were piled on top of one another in front of the morgue, and the street was slick with blood. Relatives picked through the bodies and pulled some out to bring home. More bodies piled up on the street outside the hospital.

In the courtyard, survivors held on, cared for by relatives or by strangers. Many victims had waited in line so long they had grown dehydrated and needed intravenous fluids before they could undergo surgery.

“It’s a catastrophe. It’s a human disaster,’’ Georges Boutin said. “Just the smell alone. Have you ever smelled death before?’’

Together, father and daughter peered over the patient. Lights strapped to headbands illuminated the woman’s leg.

“It hurts, it hurts, there’s a lot of pain,’’ the woman moaned in Creole to Pier Boutin, who held her hand and spoke to her in French.

“Breathe,’’ Georges Boutin told her.

An anesthesiologist prepared to put her to sleep, then Georges Boutin held the woman’s leg as his daughter sawed the bone with a handsaw.

Outside, a woman cried and called for her mother.

With the amputation successfully underway, other doctors went to get a patient to be treated in an adjoining room.

Seconds later, they wheeled in a frightened 7-year-old, Balnave Ulysse, wearing a yellow soccer jersey. He had lost one foot. His father was dead, but his anxious mother waited outside.

They tried to soothe him. “Can you tell him he’ll feel a poke?’’ Dr. Patrick Shanovich of Los Angeles asked a translator as the boy sobbed.

Jacques Lorblanches, a 64-year-old doctor with Medecins du Monde, a nonprofit based in France, stood in the operating room and said Haiti was the worst disaster scene he had ever seen. He worked in Iran after a massive earthquake in 2004. But unlike Haiti, he said, Iran had many well-equipped hospitals.

When he arrived in Iran shortly after the disaster, the critical cases had already been triaged, and many hospitals were available. In Haiti, they are rebuilding the hospital themselves with buckets, supplies, and sheer ingenuity.

“It’s much worse here,’’ he said. “We have no radio, no electricity, no nothing.’’

Helping lead the effort was Ernest Benjamin, a doctor at Mount Sinai Medical Center in New York. Yesterday, his task was to sterilize the operating room, in the middle of surgery.

Asked what he needed, he said, “everything.’’

“Orthopedic surgeons. Anesthesiologists. Nurses. We need supplies,’’ said Benjamin, who was born in Haiti but has lived in the United States since 1979. “We’ve already passed the critical 72 hours after a disaster where you can save people, so it’s urgent. Time is of the essence.’’

Much of the care is delayed by basic tasks, such as looking for a roll of tape, that would ordinarily take seconds. Tubs were filled with Tylenol, Motrin, tracheal tubes, and gloves, but they needed much more than that.

Claire Pierre, a physician born and partly raised in Haiti who now lives in Boston and works at Cambridge Health Alliance, raced around the hospital campus, searching for basic supplies. Her mother’s home was destroyed and she fought her emotions as stories of dead friends and teachers trickled in.

Like the other physicians, and patients, she was determined to stay calm. She rushed to the supply closet. “We have no alcohol,’’ she told a man at the supply closet, anxious to bring supplies back to the operating room.

“OK then, water?’’ she asked him. “You guys have water?’’

The man ran off and she waited. “We need water to clean wounds,’’ she explained. “Big amounts of it, almost like a fire hose . . . , ’’ she paused, “but we don’t have that.’’

In seconds, the man returned with three containers of rubbing alcohol, which she gladly accepted.

As she rushed in the direction of the operating room, a man holding a handmade wooden coffin above his head walked silently up the street.