Bayhealth Medical Center Trauma Surgeon Dr. John Brebbia is Critical Care Director for Milford Memorial Hospital and Wound Care Center Director for Kent General Hospital. Brebbia joined a Delaware contingent of doctors and healthcare professionals who traveled to Jacmel, Haiti recently and treated earthquake survivors.
Q We’ve heard about transportation problems for relief workers traveling to Haiti. What was it like for you?
A Let’s say it wasn’t routine. We flew from Philadelphia to Santo Domingo in the Dominican Republic. From there, we took a nine-hour bus ride to Cabo Rojo, and then we took a six hour boat ride to Jacmel, Haiti.
Q What was your first thought when you arrived in Jacmel?
A My first thought was about the unbelievable devastation. You can see the pictures on TV, but you can’t really get a sense of it until you stand at the foot of the city. It’s not just one house, not just one block, but the entire city came down. Unbelievable.
Q How did the Haitians react when you arrived?
A On the first day, there was a fair amount of bureaucracy. In spite of the devastation and the carnage, the mayor of Jacmel didn’t want us to treat anybody until he talked with the hospital administrator first. Once we started treating the injured, people started coming from everywhere. Many people came to us from outlying areas and even from Port Au Prince, where I think the relief people were overwhelmed. People were traveling great distances to get to the medical team in Jacmel.
Q What type of injuries were you treating?
A Since I’m a surgeon, most of my work was surgical. This included amputations of dead limbs, limbs that had been crushed from falling debris, and big open wounds created from concrete that had fallen and gouged out big areas of skin, fat and muscle. There were a lot of hand and foot injuries where tendons were exposed and the limbs were crushed to the point where they couldn’t survive. There were toes, fingers, hands, legs that all had to come off because the tissue was necrotic (dead) and if we didn’t amputate, the infection could progress to the point where they’d probably die. Once my surgical stuff was done for the day, I would go down and help with the general medicine. There were many primary care issues, from vaginal infections to bladder infections, ear infections, and worms. Worms are a very common medical problem with the children. These kids didn’t get worms from the quake but got it from unsanitary conditions. They live in areas where there are livestock and animals, and where people are urinating and defecating out in the open, right near where people are eating and living. And, the people cannot afford medical treatment.
Q What about the quality of your surgical equipment and supplies?
A We had to do the best with what we had. I had scalpels, clamps and a saw to perform what they call a Guillotine amputation. I used the saw to cut through to the bone and then put sutures in the arteries and veins and then put dressing on. We had no blood available for transfusions so we had to be very careful and use a tourniquet around the limbs to limit the blood loss. We had local anesthetics to numb up the limbs and eventually we were joined by an anesthesiologist and nurse anesthetist. But, we had no monitors for vital signs, so we had to put a stethoscope over the chest and listen to the heart and lungs during surgery. It was clean, but not a sterile environment. We set up our operating room with a tent from the Canadian military and then we covered the dirt floor by tying four tarps together. There was still a lot of dust in the air.
Q What did you learn from this experience?
A One thing we learned is that the poverty was not from the earthquake. They live in horrid poverty all the time. They have no primary care medicine. When they heard doctors were in Jacmel, people literally came out of the hills to get treatment. We’re not just taking care of wounds but primary medical problems. We treated a lot of injuries that had nothing to do with the earthquake. It’s really hard to describe how poor they are. I’ve been to Third World countries and this doesn’t even measure up to a Third World country. Their homes are shacks made up of this, that, and the other thing. One wall might be cardboard, another wall might be sheet metal tied to a piece of wood. There were many people who had not eaten for days and could only get food from relief organizations delivering food. People are sleeping out in the open street in the rubble and, if they have to urinate or defecate, they go right there out in the open.
Q What was your most heart wrenching moment?
A In one of my surgeries, I had to amputate the foot of a two-year-old girl. She came out of the mountains and her wound had been left open for 13 days. It was horribly infected, her foot was dead, and there were maggots and flies in her foot. Her foot had to come off, and I had to do it. Although I’m glad to be home, I also feel guilty that we are leaving them behind like that. I don’t know how they can live like that. I don’t know how we can allow them to live like that.
Milford, Del. —
