January 24 Update

This is an extract from the diary of Dr. Malcolm Smith (MGH)

"Thank-you everyone! We are all fine, although have had no time to text since yesterday.

Things here starting to work. We are coming off critical triage mode, but have masses of work to do, fixing dozens of people who have had very serious, but non life-threatening injuries, which we have not been able to deal with, while we were working full-time in life-saving mode. Much the same message coming from some other surgical units working here. It sound like surgically it's "game on", and docs beginning to put people back together. Those of us working at S Marc are now, essentially, starting to put people back together again. You can't imagine the
emotion this creates. Moral soared yesterday as patients were coming out of OR
fixed -- then we had 2 deaths during evening rounds, one a massive PE [blood clot in the lung] and another a medically sick baby. Heartbreaking. The reality of poverty and what's happened here hits you all over again when things like this happen.

We understand that the USS Comfort is working. Had contact and have heard evac helos flying overhead. We are hoping for our first evac today for their ICU, for a young woman with tetanus. None of us working here has ever seen case of tetanus before we began working here! The reinforcements that arrived here more than 24 hours ago are essentially enough to run hospital and teach local staff. Don't need more staff now that a second team from california organised by Partners in Health has arrived. We now have about 30 core people with some others co-opted in. Had major problem yesterday though, with arriving Docs etc in uncoordinated groups who want to work. One major lesson for me in all of this is that good will has to be organised to do good. So thankful for Partners in Health for the organizing they have done.

We are now doing cases with kit [orthopedic fixation equipment] sent by Synthes, and which I picked up in PoP day before yesterday, but we will run out by the end of today. Art Leary's Synthes/AO stuff [i.e. more orthopedic fixation equipment] for us has arrived, but it is stuck in the capital. I'm driving there now to get it, as contact time is set, by text message, for 8am. Contact time hopefully ok. Phones not working well today.

Port au Prince still sounds very bad. Damage there terrible. Here, at S Marc,
we found cracks in the tile in our OR Floor after the aftershock 2 days ago, and had to stop operating in that room. But it has now been checked by US structural engineers sent by Partners in Health, and all found to be OK. Decided on reflection that it is old damage, unrelated to earthquakes. Have some very basic skin graft equipment, but urgently need skin graft knife and blades. Electric dermatome best, as we have no air power and will need lots of big grafts. Old hand knife will be
difficult. Mark/Jnette can you help? Thank you for tourniquet: already saved life.

Country will need thousands of vacs. Can someone please talk to KCI? Coordination around this place is a nightmare.

We are now having problem with some of our very ill patients and their families. They have infected open fractures that are not reconstructable [i.e. they will die without surgery], but are refusing surgery,in case they require amputation. They are just frightened, because they know there is no limb fitting services in this country. Heard of same problem all over. Families take them away for second opinion which will be the same. The next phase of our efforts needs to be directed for limb fitting/prosthetics.

Any one who can help, please do!

James Toussiant joined us yesterday (our Haitian ortho resident). A gem of a guy solving many problems immediately, because he can communicatate brilliantly with our patients, not only because he speaks the language, but because he understands the culture. Still, our patients' fear of amputation and refusal of surgery is a real problem, despite his best efforts. Hoping to do 20 cases today in our two ORs, especailly now that we have enough staff to do dressings under sedation on wards!
The fact that we now have enough staff to offer kindness in care, as well as basic life saving, extremely important for the wellfare of our patients and their very worried families.

First wave of surgery expected to be done by saturday. We will then need a different team ortho/plastic surgery, nursing PT and lots of admin at this point, and all this needs to be organised carefully. Community will need lot of trained nurses. Specifically need loads of Haitian-American nurses and doctors to
bridge the gap. We feel so fortunate to have had some.

Thank-you all so much, everybody, for caring about these people, and spreading the word about the terrible things they are going through, and how much of our help they need. You can't imagine how much it means to all of us working here."

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From a recent, brief text to his wife, it is clear that Malcolm did, indeed, drive to Port-au-Prince this morning, was successful in picking up the Sythses kits, and is now back in S Marc. But his phone and text capacity is hardly working. These people need a satellite phone!