Surgeons quickly adapt to primitive operating conditions

This gallery collects all of our photos of the crisis in Haiti, starting with the most recent images and going back to the first photos that emerged after an earthquake hit the impoverished nation Jan. 12.
By David Brown
Saturday, January 23, 2010

PORT-AU-PRINCE, HAITI -- The big diagnostic mystery of the newly arrived aid group's first surgical case was the lamp.

A standing parabolic surgical light, it wouldn't turn on. Neither new bulb, alternative cord nor different plug would make it work. So the surgical team operated with camping headlamps.

The patient's problem was, in surgical terms, more straightforward: compartment syndrome of the right lower leg.

Emmanuel Etan, 21, had been trapped under a collapsed concrete-block wall for two days, rescued and then treated with a procedure to relieve the pressure caused by swelling.

It was the right procedure but not sufficiently aggressive. By Wednesday, Etan's leg was dangerously re-swollen, the pressure high enough to impair blood flow. Unrelieved, it would kill the tissue, which would become infected and require amputation -- if it didn't kill him first.

"I wouldn't call it easy. But it was less complicated than some of the cases we have waiting," said Waseem Saeed, the 46-year-old British plastic surgeon who cleaned and trimmed the wound, completed two muscle-opening cuts and cleansed Etan's deep hand wound. He worked in the semidarkness of a 30-by-24-foot tent erected on the asphalt courts of a tennis club. There was no X-ray machine and no supplemental oxygen. The temperature was in the 90s.

It took Saeed two hours. Then Etan was wheeled off to the recovery room -- the space behind the baseline on the court, next to the generator.

Next up was an 8-year-old girl named Diana, who was missing the skin halfway around her right hand. It was cleaned and the dead tissue removed. In two days, she is scheduled to get a skin graft to cover the open wound.

Saeed did three surgical cases on Thursday, his first full day operating. The clinic doctors saw 60 patients, double the day before. The team expected to do at least four operations on Friday.

More than a week after the devastating earthquake, operations such as these are starting to be done in large numbers -- designed to revise hasty or incomplete earlier procedures or ones done well that have simply taken a downhill course.

The organization Partners in Health has 12 operating rooms working in the university hospital here. The Navy floating hospital USNS Comfort began taking patients on board Tuesday night. Many other relief agencies and national governments also have surgeons operating here.

Although the circumstances Saeed worked under were primitive, the surgical operation run by Merlin, an international relief organization, observes all the rules of antisepsis, sterile technique, post-operative monitoring and follow-up care expected in hospitals that aren't put up overnight on sports venues. The technology gap isn't even as bad as it might seem to outsiders, according to the orthopedic surgeon who procured the tennis club for Merlin last weekend.

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