San Francisco Chronicle - (Sunday)
Quake survivors face elevated risk of amputations
LES CAYES, Haiti — The home of clothing merchant Felix Pierre Genel collapsed before he could flee as a powerful earthquake shook southwestern Haiti. He was removed from the rubble that same day with a broken arm and was among the somewhat fortunate ones who promptly received medical care at a local hospital. But even so, he could not escape amputation, a common consequence of the calamity.
Doctors at first told the 36year-old they would try to save his right arm. He had surgery to stabilize the broken bone. Then came an infection and a second operation.
“Instead of dying, I took the decision of letting them cut off my arm,” Genel said from his bed at the Les Cayes’ general hospital, his right arm bandaged where doctors amputated it above the elbow. “From where I’m coming from, inside the mouth of death, it’s best that they cut the arm off.”
Broken bones that cause open wounds are frequent injuries in devastating earthquakes like the one that battered the Caribbean nation on Aug. 14. That combination causes a particularly high risk of infection, and even more so when, as in Haiti, access to health care is limited or people delay seeking medical attention in favor of natural remedies.
“The risk of infections goes up the longer you wait to get care, and some of that is related to access to health care, not all of it,” said Dr. Christopher Colwell, chief of emergency medicine at Zuckerberg San Francisco General Hospital.
“If there are fractures or broken bones that are associated with those open wounds, those infections can be devastating and can result in the need for amputation, or, in some cases, even threat to life, over the next days and weeks,” he added.
The magnitude 7.2 quake, centered under the country’s southwest peninsula, killed at least 2,207 and injured 12,268 people. About 130,000 homes were damaged or destroyed. Hospitals, schools, offices and churches were also heavily impacted.
Health care facilities were already at a critical point before the temblor because of the pandemic. Many of the injured had to wait under the blistering heat, even on an airport tarmac, for care. One hospital was so overwhelmed that it placed patients in patios, corridors, verandas and hallways.
The ability to get medical attention also was complicated by a tropical storm that trailed the earthquake and the twoday
Hospital beds fill the courtyard of a clinic in the town of Les Cayes on Aug. 15 for patients injured in the 7.2 magnitude earthquake that devastated the region in southwestern Haiti.
closure of a major hospital in the capital of Port-au-Prince to protest the kidnapping of two doctors, including one of the country’s few orthopedic surgeons.
Colwell, who was not in Haiti, said natural remedies can have varying degrees of success, but some not only are unhelpful, they are harmful and can even introduce bacteria that lead to infected tissues.
In the weeks after a massive earthquake struck Haiti in 2010, hospitals only admitted patients in the most serious conditions. Some with simple fractures that did not expose the bone through the skin left without seeing a doctor, only to return later with complications and serious infections.
The nongovernmental organization Humanity and Inclusion concluded that as a result of the complications, “amputations represented an exceptionally large proportion of the surgical operations” and
added, “Some amputations performed under extremely difficult circumstances required corrective surgery.”
The organization estimated the number of amputations at between 2,000 and 4,000, with at least 1,000 people requiring a lower limb prosthesis.
Far fewer people were injured this time compared to 2010, when at least 300,000 Haitians were hurt and the government asserted that a similar number of people died. The group now has a team in Haiti assisting health care personnel and assessing patients’ needs. They can examine scars and stumps, teach patients exercises and work on joints to avoid muscle stiffness. They also help psychological support efforts.
“People can be traumatized, and they can be very sad, depressed, but also some of them, they’re kind of in denial, and they believe extremely strongly that their life is going
to be the same, which can be true, but same but different,” said rehab specialist Virginie Duclos.
Governments too have sent aid to southwestern Haiti, including the U.S. military, which dispatched a surgical team.
The aid group Samaritan’s Purse also opened an emergency field hospital in Les Cayes a week after the temblor. “When we opened, we saw many people who were seeking care for the first time — and that was already a week after the earthquake — with broken bones and with wounds,” said Melanie Wubs, medical director for the field hospital.
She said others “had been hastily patched up right after the earthquake but now required more further care.”