Haiti: a day in MSF's emergency trauma hospital in Port-au-Prince
When MSF’s hospital in the Tabarre area of Port-au-Prince, Haiti, opened on November 27, it reached its initial capacity of 25 beds within two weeks. The medical needs reflect a high level of violence as a political and economic crisis continues in the country. Since September 2019, widespread demonstrations known as peyilòk (which roughly means "closed country") have taken place in Port-au-Prince and beyond, with barricades in the streets, protests and clashes.
It is 9am on Sunday, December 8, when the first patient of the day arrives at the MSF hospital.She is a 29-year-old woman with gunshot wounds. Her hands are swollen and bloody. The teams—doctors, nurses and stretcher-bearers—attend to her immediately. "Bandits ordered her to put her hands together before shooting her twice," a nurse says. The X-ray reveals a double fracture on each hand.
The hospital admissions criteria are strict and it admits only patients who need emergency trauma care. "We want to focus on patients who need lifesaving care, because we do not have unlimited capacity, and we want to mobilize our resources for the most important cases," says Jean-Fabrice Pietri, MSF project coordinator.
"We knew we were meeting a need here, in terms of serious and urgent cases, but obviously the situation is even worse than we imagined, so we will have to adapt quickly enough, and go faster than we had anticipated," Pietri says. In the first three weeks, more than 250 people were triaged at the hospital, more than 100 of whom were hospitalized. The staff has had to add beds quickly to cope with the high number of patients, and the hospital is approaching its planned capacity of 50 beds.
Jean-Baptiste, the second patient of the day, was injured in a motorcycle accident. He was struck by the bumper of a van and suffered injuries as he was dragged for several yards. He has a severe open fracture in the right tibia and burns on his hands and has lost a lot of blood.
Once he is stabilized and his leg is X-rayed, he is rapidly taken to the operating room. "With him what we saw was a very extensive wound on the anterior side of the lower leg, where he lost all his skin," said Australian Dr Thomas Schaefer, an orthopedic surgeon. "There's an underlying open tibia fracture, and so you have fascia, muscle and bone altogether on view, which makes this a very, very extensive case of an open fracture."
The patient requires an external fixator to hold his broken bone in place, skin grafts and a long hospitalization. Because the wounds left his nerves and arteries largely intact, the team treating him believes his leg is likely to heal.Like Jean-Baptiste, people admitted to Tabarre often require several days or even weeks of hospitalization, because of the seriousness of their injuries and the number of operations necessary for their recovery.
Some patients can be stabilized, treated and discharged after only a short hospital stay. Jameson arrived a little after 11 a.m. that Sunday, in shock and with a large wound on his left shoulder.
He is a 28-year-old father of three, and was attacked while playing dominos with friends. He suffered multiple stab wounds. "The path that the weapon took in his body needs to be explored," says Thierry Binda, the medical activity manager. "We don't know the weapon and we don't know the trajectory and the depth of the wounds. This requires the patient to be hospitalized, while the patient is at risk. After an observation period, the patient can be discharged if, through our monitoring, we are certain that there are no complications."
Jameson's X-ray revealed that there was no lung damage, and after treatment and two days in hospital he was able to return home.