Dr. Barry Koffler is an orthopedic surgeon in Atlanta, Georgia (and he is also our uncle). He has been practicing medicine for over thirty years, and does volunteer medical work in Central America. A few weeks ago, horrified by the devastation in Haiti, he left everything and went to help. It wasn’t easy to get there, but he found a way. He took the time to tell us about his experience.
How did you get to Haiti? Where did you land?
I flew to and from Haiti on private jets donated by wealthy philanthropists who are part of a Christian Missionary group called MFI, or Missionary Flights International. The flight to Haiti was in a beautiful five passenger jet and the return was on a large turbo prop jet owned by a race car driver. The flight there was interrupted by a short stop in Exuma, Bahamas to refuel since there was not likely to be enough fuel in Port Au Prince for the refueling of private jets.
Can you describe the scene when you arrived? Who was in charge?
When I arrived in Haiti, the airport looked like a military base with tents everywhere. I saw flags from many different countries, including Central and South American, European, and Asian countries. There were representatives from all over in the airport, but mostly from the United States since the airport and airport traffic was being controlled by the US.
Haitians lined the road out of the airport hoping for food and water. The streets were filled with trash, and makeshift tents made of blankets, sheets or whatever people could find to offer some kind of shelter and privacy at night, lined the streets. Almost no one had work. The people stood, talked, and watched all day. Large parts of Port Au Prince have totally collapsed, and many bodies are yet to be found. Many people were trying to escape the city, since it will be years before the infrastructure is rebuilt. And it is filthy. People were drinking from the same water they bathed in. There was no garbage collection, no running water, and no electricity in the city.
Where were you taken to treat patients? Were you in Port Au Prince the entire time? Were you working in a hospital? A tent?
I was taken 10 miles outside of Port Au Prince to a place called Caberet. It was an hour and a half drive because of traffic and the poor condition of the roads. I was taken to a Christian mission which – in the best of times – is an orphanage and school. Only 25% of Haitian kids get any education.
Post earthquake this church became a drop off point for post-amputation observation, for fractures and for orphans of the quake.
What kind of injuries did you see?
The injuries were primarily crush injuries. The extent of the severity ranged from traumatic amputations, to open fractures, and to closed fractures. There were also closed nerve injuries from nerves struck by heavy stone, and nerves damaged by pressure from soft tissue swelling called a ‘compartment syndrome’. The amputations had to be kept clean, and those that were infected needed to be debrided. The open fractures had to be set or sent to Port Au Prince for more definitive treatment.
Can you tell us about any specific cases?
The devastation was indescribable. There were people on the clinic floor with broken legs, broken arms and amputations. Within the first two hours after arrival I had reduced and casted two children, one with a femur fracture and one with a tibia fracture. Their pain was gut wrenching but after getting them immobilized, the smiles were equally poignant. I casted an adult with bilateral femur fractures who lay on the floor in agony with every twitch of her leg muscles. We found a small table that I was able to move her onto, reduce the fracture, and cast. No x-ray, no anesthesia. As I was about to leave the clinic, I saw a little boy on the floor with a high femur fracture. Ideally, he would have been treated with surgery, but that wasn’t possible. I was able to put him on the small table, reduce the fracture and put him in a spica cast, which is something I hadn’t applied in more than 30 years.
What is the supply situation? Did you have the necessary equipment?
I was able to cast many broken tibias and femurs that were closed. I ran out of plaster quickly – long before I ran out of strength – as what I had brought with me was grossly inadequate, and the church didn’t have much either. Fortunately the manager of the Belgian unit was kind enough to give me a case of cast padding and plaster casting material. I used every roll and was able to cast every one of my patients who needed a cast. When I finished, I did not have one drop of plaster left. Casting was not the best treatment for many of the hip fractures and femur fractures, but there was no other option. There was no operating room with hardware to fix the kids with hip fractures. I ran into a pediatric orthopedist from the Children’s Hospital in Dallas and he told me they were manipulating and casting as well.
With no x-ray to guide me, I did all of my work by feel, blind luck and faith. Two of my patients died, one of septic shock after an above knee amputation, and the other because of a tension pneumothorax after a road accident. She couldn’t breath and we didn’t have a chest tube to help her.
What kind of follow-up care will be available to the injured?
Follow-up will be the subacute phase of this crisis. Casts need to be removed, patients need therapy, those with problematic stumps will need revisions, and those with amputations will need prosethetic legs. Hopefully the world will not forget these people when the media stops covering the crisis.
The greatest tragedy of all is the orphans. There are even more now in country that had too many before the quake. There were five orphans who were taken to the US on the jet that I arrived on, and the day after I left, the last of our patients who were orphans were flown to northern Haiti by a philanthropist, hopefully to start a new life.
Everyone understands that there is a vast amount of devastation in Haiti, but seeing it first-hand must have been overwhelming. How did it affect you? What were your feelings while there, as you left, and now that you’re home?
Sleep was sparse in Haiti. Roosters crowed all night long. Hungry, emaciated dogs barked, but the shock of what I saw was the most likely cause of my sleeplessness. At 4:30 am the people in my compound got up to pray. At 5:30 they sang Amazing Grace. Hearing it was a very poignant experience that I will never forget. This was one of those experiences that is beyond words.
Photography by: Jo Ann Beltre