PORT-AU-PRINCE, Haiti – Two weeks after a massive earthquake leveled much of this impoverished city, a wave of new infections and injuries has emerged, further taxing the nation’s shattered health care system.
Patients whose wounds were treated in the chaotic days following the quake are now returning with deep infections, the legacy of squalid conditions that make it impossible to keep open sores clean.
Rashes and gastrointestinal ailments, byproducts of the lack of clean water and sanitation, are becoming more common. And daily life on streets littered with rubble and marked by hopelessness is exacting a toll, as careering vehicles strike pedestrians and sprays of buckshot inflict wounds.
The shifting trajectory of suffering in Haiti is visible at a disaster field hospital staffed largely by medical workers from New England. Inside a taupe tent, an 18-year-old spiraled downward swiftly over the weekend.
He had undergone surgery elsewhere, his pinky finger and a chunk of his hand amputated. He arrived at the mobile hospital, erected in a school courtyard, with a stiff neck. The amputation wound was clearly infected. Diagnosis: tetanus, a fast-moving and lethal disease informally called lockjaw because of the rigidity it causes. The teen received antibiotics and other medication.
“Despite the treatment,’’ said Dr. Gary Fleisher, pediatrician in chief at Children’s Hospital Boston and a veteran member of disaster response teams, “he progressed and developed much more severe muscle spasms. His jaw would clamp down, he’d bite his tongue.’’
Doctors at the field hospital transferred the young man to the USNS Comfort, the Navy ship anchored off Port-au-Prince that has become the refuge of last resort for the most seriously ill. Physicians at the field hospital held scant hope that the teen would survive.
Disease trackers from Haiti and other nations, including the United States, are so concerned about secondary health threats in the aftermath of the earthquake that this week they are going neighborhood to neighborhood to assess the state of water and sanitation, housing, and health.
“It’s to get a snapshot of where we are right now,’’ said Captain Peter B. Bloland of the US Public Health Service. “Because of crowding, there may be places where infectious disease may be more likely to cause an outbreak. And if people are sleeping in the outdoors, they’re going to be more exposed to mosquitoes and malaria and dengue.’’
At the same time, disease specialists have begun regular surveys of 52 medical sites, hoping to detect outbreaks and stanch them.
At tent wards established by Doctors Without Borders, medical workers are seeing many whose wounds are in desperate need of cleaning or whose wound dressings need to be changed.
And the pharmacy at the field hospital in the school courtyard is dispensing increasing amounts of antibiotics to combat infected wounds.Continued…
“At home in the United States, you would clean your wound with soap and water or peroxide, or you would go to the hospital if it was severe enough,’’ said Shannon Manzi, a Children’s Hospital Boston pharmacist who serves on the Massachusetts-1 Disaster Medical Assistance Team. “Here, they don’t have anything to wash their wound with, so they’re getting infected.’’
If the experience during recent earthquakes in China and Pakistan holds true in Haiti, those infections will prove difficult to treat.
In those quakes, the bacteria that stole into wounds were not garden-variety germs susceptible to routine antibiotics. Instead, the infections were caused by multiple bacterial strains not easily thwarted by standard drugs.
But identifying bacterial strains in Haiti, so that patients can be given the specific antibiotics likely to work best, is hampered by the widespread damage inflicted on the nation’s medical network.
“We haven’t really identified a good functioning microbiology laboratory because a lot of the laboratories were damaged,’’ said Dr. Greg Elder, deputy operations director for Haiti at Doctors Without Borders.
For some patients plucked from the detritus of the earthquake, the threat to their health did not become obvious until days later. Initially, they appeared unscathed, with few outward signs of life-threatening injury.
But with time, injured tissue inside their legs and arms swelled profoundly, with nowhere to go.
“It’s basically like a balloon that can’t expand any more,’’ said Dr. Jon Crocker of Beth Israel Deaconess Medical Center, who was volunteering last week at a hospital in Cange run by Partners in Health, the Boston-based group that operates 10 hospitals in rural Haiti.
As the swelling intensifies, a chemical is released that clogs and shuts down the kidneys. Patients can die without dialysis, a service in short supply before the earthquake and now believed to be available at only two sites nationwide.
The wages of violence are also evident on medical wards. Teams from Doctors Without Borders, for example, report an increase in gun and machete violence in some Port-au-Prince slums. And the Massachusetts medical teams in the capital have treated patients sprayed with bullets, as well as a 61-year-old man whose head was bloodied by attackers when his cellphone was snatched.
On Sunday, two doctors from the Boston area hovered over a gravely ill 4-day-old boy. They feared he had tetanus and, possibly, meningitis. When he was born, his parents only partially severed his umbilical cord. The rest remained attached, creating a portal for disease to seep in.
“After delivery, they’re in their mom and dad’s house, and because of difficulty keeping clean, they get dirt around the umbilical cord,’’ said Dr. Jeff Hersh, medical director at Boston Scientific and a member of one of the disaster medical teams. “The tetanus can get in through their umbilical cord, and it goes all over their body.’’
Hersh cooed softly as drugs flowed into the infant’s tiny body via intravenous lines. The doctors were not optimistic about the outcome. But, like so many things in Haiti in the days after the earthquake, there was no certainty.
Stephen Smith can be reached at stsmith@globe.com.
“
