ARTICLE IN BRIEF
Three neurologists rushed to Haiti help with patient care in the aftermath of the Jan. 12 earthquake.
It's estimated that about one third of the nine million people living in Haiti were affected by the Jan. 12 earthquake and numerous survivors have suffered brain and spinal cord injuries. But even before the tragic event, there was not a single neurologist practicing in this impoverished country. So when the earthquake hit, several AAN members scrambled to find transportation and collect equipment and supplies to do what they could to help. Although they came from different backgrounds and practice settings, all had close ties to Haiti and knew that their expertise was needed. They shared their stories — and experiences in Haiti — in phone and e-mail interviews with Neurology Today.
DR. SERGE J.C. PIERRE-LOUIS
Serge J. C. Pierre-Louis, MD, MPH, arrived in Port-au-Prince on Jan. 21 to find the Toussaint Louverture International Airport badly damaged and barely functional. Because of the chaos, he was unable to contact members of the Association of Haitian Physicians Abroad, www.amhe.org with whom he had traveled, so an old friend picked him up and gave him a tour of Port-au-Prince.
“I had never seen so much devastation before...so many houses were twisted and crumbled,” said the associate professor of neurology at Rush University Medical Center, who had been raised in the Haitian capital and had moved to the United States at age 24. Most of the institutions he had grown up with — the National Palace, his elementary school, part of his medical school — had all been flattened by the earthquake. He later learned that his sister, a pediatrician living in Port-au-Prince, had just left their mother's four-story office building minutes before it had collapsed.
During his stay in Haiti, he worked 12-hour shifts in the Hopital de la Communaute Haitienne, a 50-bed community hospital, along with an OR nurse, ophthalmologist, and neonatologist from Chicago. The first two days, he did neurology consultations and saw a variety of conditions including cerebral contusions with weakness and visual loss, spinal cord trauma, and stroke with uncontrolled hypertension. “The most touching patients were the countless ones suffering from long bone fracture and amputations,” he said.
Other patients included a 28-year-old woman with known depression who became agitated after the quake and attempted suicide with a drug overdose, and a 44-year-old man who developed hysterical blindness while caring for his injured son at the hospital. Resources at the hospital were scarce, but international teams had brought equipment that could be used in the ICU and would supply several makeshift operating rooms, as well as medication such as steroids for the treatment of cerebral edema. Critical patients were transferred to the US Comfort naval ship or to international tent hospitals at the airport, and later, to the United States.
When Dr. Pierre-Louis arrived it soon became clear that no one knew how many patients or medical workers were there and so his training in public health and experience in management came in handy. For the rest of the week, he mainly worked in administration managing about 270 health workers from 12 different countries and training the local clerical staff. In between, he and his group drove out to gather medical supplies, help a damaged orphanage, and visit other hospitals including the many international tent hospitals. Food was scarce and at times they used their own supplies.
Dr. Pierre-Louis, who is associate chairman of the Division of Neurology and director of the Epilepsy Program and Neurophysiology Lab at John H. Stroger Jr. Hospital (formerly Cook County) in Chicago, had volunteered a year earlier at a recently opened epilepsy clinic staffed by a neurosurgeon and pediatrician, but when he visited them after the quake he found the shaken staff had stopped performing EEGs and were providing basic care to the injured. Dr. Pierre-Louis returned to the US on Jan. 28, having lost many friends and colleagues in the quake. He fears more deaths will occur due to cholera and typhoid when the rainy season starts this month.
DR. ANTHONY G. ALESSI
Anthony G. Alessi, MD, a private practice neurologist from Norwich, CT, who had traveled to Haiti on three prior missions with the Norwich-based Haitian Health Foundation to work at its clinic in Jeremie, volunteered at St. Damien Hospital, the only free pediatric hospital in Haiti. Dr. Alessi's typical work day at St. Damien's began in the pre-dawn hours, when along with translators, he visited patients he had examined the night before.
At 8 AM, he attended a staff meeting with other medical and surgical specialists during which schedules were reviewed, patient care issues addressed, and he recorded the names of patients requiring neurologic consultation and those needing transfer to the USNS Comfort hospital ship. Doctors requested supplies — bedpans, crutches, foam rubber to line cribs, ID bands, and extension cords — for him to obtain from the ship. An hour later, Dr. Alessi would wait for the helicopter at a landing zone near the U.S. Embassy with his patients on stretchers in the back of a pickup truck. After arriving on the ship, the patients were quickly evaluated and often scheduled for surgery. Over the next several hours, he and others would maneuver as many as a dozen patients down a gangplank and onto a motorboat. On shore, their vans weaved through the brutal Port-au-Prince traffic back to St. Damien's.
Debris made many roads impassable and caused extreme delays. Evenings were chaotic because St. Damien's was now functioning as a general hospital; victims of car accidents, shootings and any number of other emergencies would make their way to the gates. Many patients with previously controlled conditions such as diabetes, high blood pressure, or epilepsy had lost their medications in the rubble and would arrive critically ill. Dr. Alessi who arrived on Jan. 29, left on Feb. 5 and returned to Haiti again on March 8.
DR. JEFFREY K.BIGELOW
Jeffrey K. Bigelow, MD, MPH, currently a third-year neurology resident at Yale-New Haven Hospital, had been to Haiti four times before. The 2010 Palatucci Advocacy Leadership Forum graduate arrived in Haiti with a team of 125 people from Utah that included 15 doctors, 15 nurses, 10 other medical professionals, and a team of about 30 construction workers; he was one of 70 fluent in Haitian Creole. They stayed in tents in a field in Port-au-Prince as guests of the Army 82nd Airborne battalion, which provided them with security and transport to and from the hospitals. They ate ready-to-eat military meals and a few Haitian meals, which made many ill. Dr. Bigelow's first day was spent at the airport as medical support for about 70 orphans who were able to fly home on his chartered flight.
The next day, he went to a makeshift tent hospital that had been placed next to the nonfunctional General Hospital buildings in downtown Port-au-Prince; there were about 10 tents designated for pre-surgical, postsurgical, and emergency care, as well as an ICU. His group assumed care of the ICU tent for the duration of their time, arriving at the hospital every day at about 8 AM and staying all day. He saw patients who were comatose, often with high fevers, breakthrough congestive heart failure and seizures, gunshots wounds, and complications from crush injuries. Despite being an ICU, they had no ventilators and many patients died. They also had only basic laboratory data, no EMG, EEG, or CT and MRI scanners.
He was the only neurologist at the hospital and as soon as he arrived people began giving him consults — with heartbreaking stories. One involved a mother, who in trying to save her 11-month-old baby by positioning her body, was hit in the back by a wall and became paraplegic with loss of bowel and bladder from T12 down. She had had no imaging of her spinal cord and was sent after a couple more days to the naval ship, well outside the window of intervention.
Another was a 22-year-old girl who had been hit in the head and was unconscious for two days with blood coming out of her ears; when Dr. Bigelow examined her about two weeks into the process, he felt she had a posterior fossa bleed, but again, this could not be confirmed. He also saw multiple people with brachial plexus injuries and nerve crush injuries leading to wrist drops, foot drops, and localized numbness.
Dr. Bigelow grew frustrated with the limitations of care and resources — of being unable to give aspirin to stroke patients, and not knowing whether to let the patients' blood pressures ride or aim for tighter control, as he was unable to determine if the stroke was ischemic or hemorrhagic. Similarly, he saw comatose patients, sometimes febrile, for which he was unable to order head CT, or even examine CSF. He would presume there was severe meningitis and treat with antibiotics, or that there might be a hemorrhage, but there was no way to confirm his suspicion. Some patients worsened and died, others got better.
On the last day, a cousin picked up a patient in an SUV from the ICU, and took him to an outside private facility where he had a CT scan of the head for about $200. He had a moderate sized bleed in his right basal ganglia and Dr. Bigelow's team managed him conservatively with blood pressure control. “This was a patient with means; before this no doctor at the hospital even knew there was a functioning CT scan in Port-au-Prince, but regardless, no other patient would have been able to afford this fee,” he said.
Dr. Bigelow saw primary care patients at a “tent-city clinic” where he met Sean Penn who was helping supply the former Haitian golf course, which is now the home to 75,000 Haitians. He spent another day at Healing Hands for Haiti clinic, where he had served on prior missions, also providing primary care along with some rehabilitation.
“It's hard to measure how much of an impact I was able to make,” said Dr. Bigelow upon his return from the two-week trip on Feb. 12. It helped, he said, that he could speak the patients' language with them, and he felt he was often able to unearth history which took their care in different directions. “I was also able to explain things to patients' families and provide more direct comfort,” he reflected.
Dr. Bigelow and the other doctors saw numerous bodies pulled from the rubble and many patients die. “I was overwhelmed and impressed at the amazing attitudes of Haitians in the darkest of circumstances,” said Dr. Bigelow. This was a sentiment shared by all three neurologists and others who dropped everything to respond to the need for immediate care.