Yale Neurology Resident Heads to Haiti

After the Earthquake, Neurologists Rush to Haiti — What They Did and What They Saw

Neurology Today: 18 March 2010; Volume 10(6); pp 1,9–10

AVITZUR, ORLY MD

ARTICLE EXCERPT

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. 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.

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