Tuesday, January 12, 2010

The toll in lost lives from the earthquake in Haiti is yet to be realized but the short term consequences of the disaster may pale compared with what the future might bring. Among the buildings lost in the quake was a major hospital in the capital of Port-au-Prince. With the center of medical care gone, the question becomes, where you go for help when there is no place to go.

With technology unavailable, medical care becomes basic first aid with a wound washed out; a fracture splinted and comfort care becoming a primary goal. There is little to be gained trying to revive a trauma victim who is taking a last breath. Even if a heartbeat could be restored, there is no ventilator to breath or operating room to cure. Triage rules kick in when the number of patients overwhelms the ability to care for them.

The earthquake’s epicenter was just a few miles from the city and buildings had little chance against its force. The same situation played out in New Orleans with Hurricane Katrina where hospitals were flooded, lost their electricity and high tech western medicine found its match with Mother Nature. We learned from New Orleans that hospitals don’t provide care, people do and when the lights went out, people became heroes. Unfortunately, heroism is sometimes unrecognized and even now, lawsuits continue blaming the New Orleans hospitals for being unprepared for a natural disaster.

The USA Today reported the tragic case of an elderly woman whose lungs had failed the day before Katrina. She had been admitted to an intensive care unit and placed on a ventilator because she was too weak to breathe. Without the machine’s work, she would die. The hospital flooded in Katrina’s wake, its emergency generators failed and the woman died, even though for 15 hours nurses breathed for her, squeezing on an Ambu bag. The reason for the lawsuit? The hospital was not ready for a 15 foot flood, a height that would flood the second story of most buildings. It seems that there must be some person or corporation to blame.

Regardless, the question remains as to where one turns when help cannot be found. Photos from Haiti show people surrounding the ruins of the hospital. Perhaps they are searching for loved ones already there or perhaps they are seeking care for themselves. What they will quickly learn is that a hospital is just a building. The doctors, nurses and techs will find sidewalks and tents to provide whatever care they can. The future devastation will be that until a new hospital can be built, the future doctors and nurses of the country cannot be trained and it might take years to rebuild the medical workforce to provide care.
The same issues that Haiti will face may come true in New Orleans. The main teaching hospital remains closed and the future doctors and nurses in the city will have been trained elsewhere and encouraged to migrate to a city where their brethren are being sued for staying at their patients’ bedsides in the midst of a disaster.

In the end, it’s all about the people. New buildings, shiny equipment and all the press releases in the world don’t take temperatures, give bed baths or change sheets. Stuff can be made, but the people who use it need to be nurtured and grown. After a disaster strikes, the news coverage covers the initial emotion and tragedy but leaves the story of recovery untold. Perhaps that’s why ER is a hit series but Stroke Rehab Unit didn’t get a pilot made.

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