One of the worst natural disasters on record in the western hemisphere, Haiti’s 2010 earthquake left thousands of people trapped in the rubble of collapsed homes, schools and places of business and countless others without access to food, shelter or basic medical care.
In the hours following the disaster, Massachusetts General Hospital mobilized a large-scale relief effort to bring aid to victims in Haiti and stem an earthquake death toll rapidly climbing toward tens of thousands.
Nearly 100 Mass General volunteers deployed to Haiti in the month after the quake. Approximately 36 of these men and women were dispatched to Haiti within 24 hours of first word of the crisis as part of two federal medical disaster teams — the Disaster Medical Assistance Team (DMAT) and the International Medical Surgical Response Team (IMSuRT) — organized to provide rapid-response health care during terrorist attacks or natural disasters.
International disaster relief groups such as IMSuRT face a unique set of challenges. Many such incidents in recent memory — the earthquakes in Iran and China, the 2004 tsunami in Indonesia, even Hurricane Katrina — devastated austere environments which lack the resources and clinical facilities so desperately needed in a time of crisis. But the situation in Haiti, the poorest country in the western hemisphere, was more challenging than most.
“Poverty and political instability have left the country with next to no infrastructure and, therefore, no ability to organize the relief effort,” says Susan M. Briggs, MD, MPH, a trauma surgeon at Mass General and director of the hospital’s International Trauma and Disaster Institute. She is also founder and team commander of the MGH-sponsored IMSuRT team and part of the team that went to Haiti after the earthquake. “Supplies and medical equipment were rushed to Haiti from around the world, but the Port-au-Prince airport had only one runway and no one coordinating the planes. Relief organizations descended on the scene, but without a central organizing force, each group had to function independently.”
Despite these challenges, Dr. Briggs and the Mass General IMSuRT team set up their tented emergency mobile field hospital, stabilizing and treating patients with earthquake-related trauma, mainly crush injuries, limb amputations and open wounds. In addition, the team attended to the full range of cases an emergency unit might normally see: gunshot and stab wounds, seizures and emergency Caesarian sections.
Dr. Briggs’ unit spent eight weeks in Haiti, longer than any other international group, treating more than 3,000 patients and performing approximately 300 operations. Before leaving Haiti, the U.S. government donated the physical infrastructure of the IMSuRT field hospital to the Haiti-based Gheskio Clinic. That nonprofit group is using the tents and equipment in two locations as rehabilitation centers in Port-au-Prince.
“Mass General specialists have a unique ability to bring multidisciplinary, clinical expertise to a disaster scene and save a great many lives,” says Dr. Briggs. “And practicing medicine in such conditions makes you a better clinician, less dependent on technology and more dependent on your own skills.”
On the Front Lines of the Disaster
In more ways than one, the aftermath of Haiti’s earthquake put these skills to the test. Grace Deveney, RN, BSN, MPH, professional development manager at the MGH Center for Global Health, deployed to Haiti several times, most immediately after the quake with Boston-based Partners in Health, a nonprofit that operates several hospitals in rural Haiti. On arriving at Saint Marc Hospital located 30 minutes outside Port-au-Prince, Ms. Deveney’s team found a small, minimally functioning community hospital overrun by hundreds of patients — many with large, open wounds — packed haphazardly throughout the wards.
It soon became clear that organization would be the top priority at St. Marc. With the aid of a handful of teenage Haitian volunteers, Ms. Deveney set to work moving the wounded, numbering beds, creating identification bracelets out of masking tape and starting a charting system for patients. Likewise, a surgeon on her team volunteered to manage the scarce surgical equipment, while some nurses developed badly needed in-service training sessions on topics such as clotting and proper methods for moving injured patients.
“Our team was able to accomplish a great deal because we did our best to be flexible,” says Ms. Deveney. “We each have our special skills, but in a situation like the one we walked into at St. Marc, you have to be willing to adapt, to play any role needed, in order to do what’s best for survivors.”
Such adaptability served the many Mass General volunteers in Haiti well as they navigated complex and unfamiliar cultural territory.
Caregivers expected to confront a language barrier, but other problems presented themselves as well. For instance, some relief workers were surprised to encounter the Haitian people’s widespread aversion to morphine and immunizations. As news spread of various international aid organizations disregarding local customs or performing amputations without patient consent, Mass General clinicians made the extra effort to respect and communicate with patients and families throughout their time in Haiti.
“Understanding your patients’ cultural perspective as they make significant health decisions is imperative,” says Laurence J. Ronan, MD, a Mass General internist and director of the MGH Thomas S. Durant Fellowship in Refugee Medicine. After the earthquake, he volunteered for Project HOPE, a nonprofit organization which deployed to Haiti on the U.S. Navy Ship (USNS) Comfort, a hospital-on-water dedicated to relief and humanitarian operations worldwide. The 250-bed hospital ship can accommodate up to 1,000 patients and is equipped with four operating rooms, eight to 15 intensive care units, as well as CAT scanners and other state-of-the-art equipment.
But for Dr. Ronan, one of USNS Comfort’s greatest assets was the large group of Haitian-American Navy personnel that came aboard for the mission. “Having people present who were culturally competent and who could speak French and Haitian Creole fluently made all the difference to the quality of care we could offer,” he says. “To the American clinicians, performing a lifesaving amputation might seem like the obvious course of action. But the prospects are bleak for disabled Haitians — without wheelchairs or crutches, without rehabilitation facilities in an environment without ramps, without accessibility — so the ultimate care decision needed to be made and communicated by the patient and family.”
Ms. Deveney also attributes the successes of her Partners in Health group to the participation of a large contingency of Haitian-American nurses and the local Haitian nursing staff at St. Marc. But the Haitian people weren’t simply cultural translators; their selfless dedication served as an example to all of the caregivers, she says. Ms. Deveney and the other international relief workers were continually inspired by working alongside nurses who had lost family members, friends and homes yet came to the hospital each day to work double and triple shifts to help care for their neighbors.
“Even in the midst of the most horrific time of their lives,” recalls Dr. Briggs, “the Haitians accepted their situation, even found some joy. A chaplain formed a band, walked the hospital ward singing and everyone who was groaning in pain joined in. Their faith and resilience are incredible.”
The Challenges Ahead
In the months after the earthquake, Ms. Deveney and Drs. Briggs and Ronan made multiple trips to Haiti to assess the needs of the recovering nation and to work out how Mass General could contribute to the immense task ahead. As the assessment teams reviewed potential projects throughout the island, the hospital continued to collaborate on Project HOPE-led recovery activities, including the staffing of the Albert Schweitzer Hospital (HAS). HAS, located north of Port-au-Prince in the town of Deschapelles, made a home for rehabilitation services so critical to the survival of thousands of Haitians left disabled by January’s disaster.
Meanwhile, staff at the MGH Center for Global Health, led by the center’s director, David Bangsberg, MD, MPH, incorporated the lessons learned in Haiti into their strategy for providing relief in future disasters. Three major efforts include updating an operations manual for responding to international disasters, developing a training course for clinicians interested in working and volunteering in international settings and creating a database of Mass General clinicians who are ready and willing to respond to international disasters. “We’re assessing the entire disaster response system,” says Dr. Bangsberg. “Our goal is to centralize the information and expertise that we have and improve our knowledge and resources so we’re as prepared as we can be when the next disaster hits.”
For the many Mass General relief workers who had to return to everyday life in Boston after aiding in the earthquake recovery, there is great comfort in knowing they were able to leave something of value behind in Haiti.
Dr. Briggs’ international team started a fundraising project called Help a Haitian Friend, which allowed them to buy tents for the local translators and sanitation workers who partnered with them during their weeks-long stay. The Partners in Health team made wound care and stump wrapping training sessions for the local nurses a priority, increasing the odds of survival and recovery for the most critically wounded patients. But the greatest comfort for the volunteers was their confidence that Mass General would continue to play a role in the long-term recovery of Haiti.
“It’s overwhelming to see such large numbers of people affected — you can feel helpless,” says Dr. Briggs. “You can’t take back their losses, and you can’t do much of anything on your own. But because everyone at Mass General worked together, we could make a difference in Haiti. We gave them hope for the future.”