A surgeon writes from Cange

The surgical team operating in Cange.

Dr. Stephen Sullivan sent the following email from PIH's hospital in Cange yesterday.

We had a very successful day in Cange. Although we awoke to an earthquake, we are safe and spirit among the team members remains high.

The majority of patients have large wounds and fractures. Most of our operations have been amputations and wound care, but we started the fracture fixation today.  We started external fixation of tibia/fibula fractures and humerus fractures -  two rooms running non-stop with turnover so fast we hardly had time to break between cases. We also run a laceration/wound care station as well as a casting station.

We have approximately 20 retrograde femur rods and 20 tibial nails (but no insertion sets or interlocking screws for either). With our current patient load, we can probably use about 10 of them, but may have extra. While we do expect more patients to arrive, we wonder if there are more urgent needs in Hinche, St. Marc or one of the PIH/Zanmi Lasante sites?

We now have approximately 160 patients on the wards - down from well over 200. In the last 4 days, our team has provided approximately 90 operations and medical care for many more patients. We are doing are best to follow protocols for taking care of trauma patients.

We have a few dozen patients who will need high end care with special instrumentation not available to us (e.g. pelvic fractures, spine fractures, facial fractures).

An emerging problem is renal failure. It is worth considering checking renal status on patients at all sites who have crush injuries. Today alone, renal failure was found in 5 patients (out of 10 or so). Wound debridements and revision amputations will be the bulk of our operations for the next many many days.

In the long-term, patients will need wound care, skin grafts, tissue transfer and wound closure, and physiotherapy.

Please know that we are only able to do this because of all the support from you and others in Boston. Please give my love and greetings to our other friends in the office.

Slowly but surely, we're making a difference.

Stephen