Team leader / Trauma Section of the Relief Mission

Maxime Coles MD AMHE VP

I am certainly one of the privileged physicians who was able to go to Haiti
under the banner of AMHE.

What are the lessons to learn from the trip ?
I understood very early that we were ill prepared to take this task and
confront such devastation because we depended on the support of other
organizations to handle our activities:
From Miami to Port-au-Prince, the Scientology Volunteer group received us with
open arm to share their shuttle flight. We fested on their generosity at the
airport, on the flight, and in Haiti on their compound. They tried to clothe
us in offering t-shirts, vests because the night was cold. They hosted us
with respect and friendship.
In Port-au-prince, we arrive at 3h30 AM to see the same group take in charge
the baggages and cargo removing them from the airplane as well as the medical
supply while we as guests were sitting. We were driven in their bus to their
compound near Croix Des Bouquets because we did not have any other
arrangements. We shared their facility, we ate their food, we used their
bathroom and shower in plenty of water at their expenses. I want to thank
them for their hospitality.
At 8 AM a bus from the hospital will come to bring us to the General
Hospital but the physicians and Nurses will go first and if there were other
seat available, we will accommodate the Yellow shirts. On site at the General
Hospital, if material were lacking or needed like dressing, water,etc.. the
volunteers will be willing to find the material as soon as possible. I
appreciated the devotion and the dynamism of those volunteers most of them
young college students excited in their first mission, the tenacity of my
two sons and their EMT friends who made our day simpler in providing
transport  on stretcher for our patients to go to X rays,OR etc... I want to
thank them from the bottom of my heart.
We understood that our team will face challenges with wound care, so we
decided to divide our nurses and physicians supporting four areas : the
Emergency area, the "floor",the ICU and the OR. We had a wonderful crew
mixed by an ER physician from NY who did nor hesitate to take night call
from 7PM to 7AM at time..She covered the entire area in spite of the warning
on instability. I remove my hat to her and commend her devotion. We had also
3 pediatric physicians and 2 willing to do the same to cover the area of the
abandoned, neglected and new born kids. They worked sometimes in the
emergency area while at night they wanted to take call to protect those
baby at the mercy of the rats. They also worked with the Swiss team and Dr
Severe acting Chief in Paediatrics. .....We` understood also like the surgeons who preceded us that the Operating room  at the HUEH was a difficult area to work because the foreign teams were very territorial and hostile to a certain point...They banished or excluded the surgical and orthopedic residents on arrival. Once on the
site, my mission was to re integrate them in the system. We met with
physicians from MountSanai, Medecins sans Frontieres, Boston University team
 Michigan team , the Swiss team and the AMHE. At the beginning an Operating
Room was started by Dr E.Benjamin AMHE member from the MountSinai team  at the Dermatology building but after 10 days, the conditions were found not adequate to fit all surgeons nor the aseptic conditions were acceptable...We then moved to
the Urology building more spacious. This time Dr Alex. Dauphin was able to
simulate better a theater where cases will be able to be performed in a
better way ..but the aseptic conditions are still precarious.
Unfortunately Orthopedic closed cases can't be done in this setting and all
the fractures will have to wait a formal operating room to be done..The
Hospital boat is also refusing clean cases because of their infection rate.
We have dealt with all open fractures ...dirty wounds..We have placed
external fixators under terrible condition but the majority of the patient
remain unattended because of the lack of sterile operating room...Some goes
north to Pignon..who do not have an orthopedic surgeon or Cap Haitien whom
Last orthopedic surgeon left months ago.
The country will have to be dotted of a functional hospital where cleaned
cases can be safely performed. The present orhtopedic patient are also
lacking conservative treatment and we may have a generation of amputees to
take care of ...We will need an urgent need for PM&R physicians and also
Orthotist to help the BKA, AKA, AEA...amputations be fitted for prosthetic
devices.
We have attended meeting with the administration..Lassegue..Pierre-Pierre.
Paul Farmer and I see the will in the present team but little results. The
country is receiving massive help in food donation we will need also massive
help in hardware donation once all the long bone fractures will be ready to
be fixed in a sterile Operating room.
Too many infected cases has been returning to the operating room and now we
have applied external fixators to closed femur fractures in kids, we will
have to see the result in one month .
We all surgeons foreign or Haitians have felt the vacuum around us when
residents and local physicians can't be found to answer their call of duty
under the pretext that they are working fully in an other facility or their
house have fallen apart. The help we having for the moment is temporary and
we will need to understand that we can't abuse of it.
A new team arrive on the campus and I introduced them to the authorities and
made identity cards required to enter the General Hospital. Many of our
Haitians brothers are under rebels and you know that many are alive.
Everyday some is bought to freedom. God only will know the future of our
nation. But as a physician, we have to be prepared for the rainy season and
all water and mosquitoes borne disease it can bring including Cholera. You
need to be careful with the drinking water. Yesterday 1-28-10 many nurses
and helper started to be sick with temperature and malaise and diarrhea...Be
careful..
Lastly remember that If you are not US citizen, you will be unable to take a
military flight..So your best bet is to make sure that you are on the return
list with the Volunteer of Scientology..This is definitively a better ride
than the Military flight.
Haiti may appeared presently occupied by the MINUSHA or by the US Army, but IT will prevail and hopefully with all that help regain a respectable status in the rank of the Nations of the World...
 Maxime Coles