U.S. airlifts of injured Haitians are winding down, doctor says

More than 500 seriously injured Haitians have been airlifted to Florida for medical care in the month since the earthquake, with the most recent flight to Tampa arriving Tuesday. One of the experts who helps decide which patients come to the United States says the need for medical evacuations soon will end. His new worry for Haiti: outbreaks of infectious diseases.

Dr. Ronald Waldman has been on the front lines of some of the biggest global health crises of the past 30 years, from Rwanda to Bosnia to Afghanistan.

Now in Haiti dealing with the aftermath of the Jan. 12 quake, Waldman, the coordinator of the U.S. Agency for International Development's medical emergency response team, is rushed and weary, but hopeful.

"The situation is not perfect; it's got a long way to go," he said in a phone interview from Port-au-Prince on Friday morning. "But the progress is palpable."

Waldman, a professor of public health at Columbia University, has been in Haiti since shortly after the quake. Among his responsibilities: helping select patients to send to the United States, creating rehab facilities in Haiti's capital and laying groundwork to fight infectious diseases that will inevitably afflict Haiti during the upcoming rainy season.

A specialist in the diseases that ravage refugees, Waldman fears a "second spike" in Haitian deaths after the news crews are gone.

"We need to stay ahead of the curve," he said, a day after rains soaked Haiti's tent cities. "The risks are substantial."

You've worked closely with the five-member medical review board which meets daily to decide which patients are airlifted to the U.S. Do you see those numbers declining?

The number of patients in the pool varies considerably each evening, but the overall trend is declining. I'd say medical evacuations won't last that much longer. I'd number it in days, rather than weeks.

What kind of patients are you seeing now in need of U.S. care?

Complicated open fractures that require surgery or grafting to prevent widespread infection. Severe brain injuries, severe burns, spinal cord injuries. It's mostly traumatic injuries or the consequences of medical procedures that have been carried out in order to deal with those injuries.

Are you seeing patients who have complications from amputations performed right after the earthquake?

If an amputation occurred and the stump is healing, that's something we wouldn't consider. The vast majority of the patients being evacuated have received one or more procedures, but they require additional medical attention. Their conditions are too complex to treat here.

Doctors with some NGOs (nongovernmental organizations) say patients have died while waiting for the Haitian government to approve airlifts to the U.S. on private planes. Are you working to funnel those patients through your committee, which uses U.S. military transport?

I don't know about that situation, but we consider patients who have been receiving care at a U.S. government facility, a Haitian facility or an NGO. And our panel includes U.S. doctors, as well as a representative of the Haitian government.

But I think it's critical to understand that the numbers of patients being evacuated each day numbers in the tens. Those at risk for adverse public health consequences (in the coming months) number in the hundreds of thousands.

What's your next step?

We've got to focus on the needs of all those people who have been internally displaced, many of whom have orthopedic injuries and are going to need stump care and prosthetic devices. We're also trying to strengthen government and private health services so they come out stronger, more able to take care of the people's needs.

How are health workers preparing for the rainy season?

Shelter and sanitation loom as the most pressing of basic needs. And it's right to anticipate increases in the number of cases of diarrhea and vector-borne diseases like malaria, dengue and acute respiratory infections. It's going to be quite important to make sure the health needs are addressed effectively to prevent a second spike in morbidity and mortality.

Give me an example of how you do that when an estimated 1.2 million people are living under bedsheets and plastic sheeting.

We've established an information system in a large number of facilities and camps so we can get real-time data on when outbreaks occur. It gives us day-to-day tallies of important diseases and allows us to establish trends and focus on priority areas. And the Haitian health ministry has epidemiologists working to investigate all reports of infectious disease.

How long have you been in Haiti, and how long will you stay?

I can't remember when I got here. As far as how long I'll stay? That's indefinite.

Kris Hundley can be reached at khundley@sptimes.com or (727)892-2996.

U.S. airlifts of injured Haitians are winding down, doctor says 02/12/10 [Last modified: Friday, February 12, 2010 11:01pm]

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