Dr. Smith's Sunday report

Here are excerpts of an email report received yesterday from Dr. R. Malcolm Smith, Chief of the Orthopaedic Trauma Service at Massachusetts General Hospital, hard at work in Haiti with the team there and with support folks back in Boston. (Embedded links are mine.)

Thank you everyone. We are all fine. No time to txt much.

Things here working. Coming off critical triage mode but masses of work to do. Essentially started putting people back together again. You can't imagine the emotion that creates. Morale soared yesterday as patients were coming out of OR fixed. Then 2 deaths during evening rounds, one massive PE and one medically sick baby. The reality of poverty and what's happened here hits you again.

Understand the USS Comfort is working. Had contact and heard evac helos flying. Hoping for first evac today for ICU (young woman has tetanus). Reinforcements here essentially enough to run hospital and teach local staff. Don't need more staff now after second PIH (Partners in Health) team from California arrived. Had major problem with arriving Docs etc in uncoordinated groups who want to work. Good will has to be organised.

Port au Prince still sounds very bad. Damage there terrible. Found cracks in tile in our OR Floor after aftershock and had to stop work 2 days ago. But checked by US structural engineers sent by PIH and all OK. Damage clearly old on reflection.

Have mesher but urgently need skin graft knife and blades. Electric dermatome best as no air power and will need lots of big grafts. Old hand knife will be difficult. Mark/Jeanette can you help? Thank you for tourniquet already saved life. Country will need thousands of vacs.

Coordination around the place is nightmare and have problem with patients. With infected open fractures that are not reconstructable, refusing surgery in case they need amputation. They are just frightened and know there is no limb fitting service. Heard of same problem all over. Families take them away for second opinion which will be the same. Next phase needs limb fitting/prosthetics please! James Toussiant joined us yesterday (our Haitian ortho resident). Gem of a guy solving many problems immediately, but the amputation problem is still real despite the communication. Hoping to do 20 cases today in 2 rooms but also have enough staff to do dressings under sedation on wards! Kindness in care as well.

First wave expecting to be done by Saturday. Will need different team ortho/plastic surgery, nursing PT and lots of admin. Community will need lots of trained nurses. Specifically need loads of Haitian/American nurses and doctors to bridge the gap. So fortunate to have had some.

Robin and Mary, thank you so much for all the work you have been doing at home. You can't imagine how much it means.