On February 27, 2010, at 3:34 in the morning, Chile was jolted by one of the five most powerful earthquakes ever recorded. The earthquake, a magnitude 8.8 on the Richter scale, killed hundreds of people and left over a million people displaced and without shelter. Damage to property and infrastructure has yet to be finally calculated, but it is in the tens of billions of dollars. The quake created a blackout that affected 93 percent of the population of Chile. Seismologists estimate that the earthquake was so powerful that it may have shortened the length of the day by 1.26 microseconds and moved the Earth's figure axis by 8 cm or 2.7 milliarcseconds. It also moved the entire city of Concepción 3.04 meters (10 ft) to the west. The capital, Santiago, moved almost 24 cm (10 inches) west, and even Buenos Aires, about 1350 km (840 miles) from Concepción, shifted 3.9 cm (1.5 inches). The epicenter of the earthquake was offshore of the Maule region, approximately 11 km (6.8 miles) southwest of Curanipe and 100 km (71 miles) north-northeast of Chile's second largest city, Concepción.
Chile is a long, narrow country of mountains; it is a trembling and brave land populated with a hearty and proud people (Fig. 1). We have always lived with the trumpets of war, hoots of “set on fire,” floods, volcanic outbreaks, and, most of all, earthquakes. We have a longstanding history of earthquakes. On May 22, 1960, we were struck with a magnitude 9.5 quake in almost the same location as our 2010 quake; that quake caused a tsunami that brought death and destruction not only to the Chilean people but also to people in Hawaii, Japan, and the Philippines.
At the time of the February quake, we were still grieving over the tragic earthquake that struck Haiti on January 12, 2010; little did we know that we would be hit only 6 weeks later with a quake that was 1000 times more powerful than the one that devastated the country of our Caribbean brothers and sisters. Mercifully, we had fewer deaths because our buildings were better able to withstand the shaking (Fig. 2). Regardless of this, however, our authorities lost time and never guarded against a tsunami that came onto the continent 10 minutes after the earthquake as a frantic mass of water that finally demolished houses and cars, taking away men, women, and children (Fig. 3). We estimate that there are at least 1000 dead, with thousands more injured, many seriously. The experts reckon nearly 20 percent of all structures, roads, highways, and other infrastructure have been damaged or destroyed (Fig. 4). An estimated 1.5 million people are homeless. Sadly, the earthquake released not only the fury of nature but also the ugliness of people. A number of cities in Chile were looted and plundered by opportunistic vandals eager to take advantage of our country when it was knocked to its knees. Simple and defenseless settlers asked for protection that also came late, with soldiers in the streets as guardians of law and a curfew (Fig. 5).
As we write this editorial, our grief is big (as it is for all of our people in Chile) after nature knocked us with an earthquake. We have one knee on the floor but the other one is ready to stand up once more.
In such disaster, where does a plastic surgeon fit? How can we help a country torn apart by nature and a mob?
It is imperative to treat casualties after an earthquake through a team effort in which emergency medicine settings provide the leadership with the support of trauma surgeons, orthopedists, neurosurgeons, critical care practitioners, and so on. In this country, such multidisciplinary emergency medical teams include plastic and reconstructive surgeons, because wherever there is the risk for traumatic multiple casualty incidents, a plastic surgeon will be required. Accordingly, plastic surgeons play an integral role in the treatment of acutely injured victims of catastrophes, especially when one considers the nature of many mass casualty disasters, where the role of plastic and reconstructive surgery becomes even more important.1,2
In Chile there are 100 board-certified plastic and reconstructive surgeons who have completed 3 years of general surgery training before entering a new training field of 2 more years of plastic surgery that includes training in trauma. Here, our specialty is truly respected by general surgeons, who act as leaders of trauma support care networks. After this catastrophe, the general surgeons called us immediately because we were trained with them (as general surgeons) and are respected by them. In addition, plastic surgeons have superior expertise with reimplantation, handling soft tissues, extremity and facial trauma, and burn management. All of these issues are of particular concern after an earthquake.
Our major contribution during this disaster, however, was our indisputable leadership as the most qualified physicians in the multidisciplinary trauma team for deciding and selecting with competence both the operative and nonoperative management of patients with crush injuries as well as burns. Our training is seen as indispensable for optimizing the disaster relief and recovery as well as savings for the healthcare economy of Chile, especially when we have five hospitals that were damaged beyond usability (Fig. 6).
In this tiny country, our health authorities see reconstructive plastic surgery as a key part of emergency health planning, not only in terms of specialized experience in managing many of the critical health problems of this earthquake but also in terms of increasing the resource pool of available qualified medical doctors when the medical system is overwhelmed.3 This judgment is based on a plastic surgery history that includes operative experience in all age groups and in both sexes, from head to toe.4
When catastrophe occurs, it is often accompanied by a “stranger in the shadows,” in heavy disguise, who may go unnoticed early on but who finally appears. That stranger in disguise is nothing other than opportunity.5 Maybe this opportunity will serve to make the average layperson's view of the plastic surgeon change once and for all. The wide role of our specialty is not well understood, whether inside or outside the profession. The layperson is largely ignorant regarding reconstructive plastic surgery, and our colleagues in other specialties tend to underplay its various aspects.4 Plastic surgery has equally important applications in the management of many other conditions (such as cancer and trauma) in addition to cosmetic and aesthetic surgery. These reconstructive applications, and our team approach to trauma surgery, have been highlighted during the aftermath of our earthquake. Perhaps plastic surgeons will be able to have a leadership opportunity in the Chilean medical community as a result of our admirable performance in serving our country in one of her worst hours.
The Chilean plastic surgeons represent the finest spirit of international plastic surgery. Their efforts, as touched upon in this editorial, show that plastic surgery is at the forefront of disaster management. On behalf of the Journal and all plastic surgeons, I thank all the plastic and reconstructive surgeons who have helped in the recent relief efforts following the devastating earthquakes in Haiti and Chile. They have tirelessly and freely given of themselves to help stricken peoples recover. We applaud their selfless efforts; they represent the absolute best of all that is plastic surgery.
Rod J. Rohrich, M.D.
1. Thakar HJ, Pepe PE, Rohrich RJ. The role of the plastic surgeon in disaster relief. Plast Reconstr Surg
2. Reath DB. Why am I here? J Trauma
3. Cohen M, Kluger Y, Klausner J, Avital S, Shafir R. Recommended guidelines for optimal design of a plastic surgery service during mass casualty events. J Trauma
4. Sandhir RK. Definition and classification of plastic surgery. Plast Reconstr Surg.
5. Biggs T. Houston, Texas. Personal communication, June 2009.