Anesthetic practice in Haiti after the 2010 earthquake

On January 12, 2010, a 7.0 M(L) earthquake devastated Haiti, the most impoverished nation in the Western hemisphere with extremely limited health care resources. We traveled to Milot, Haiti situated north of Port-au-Prince, to care for injured patients at Hôpital Sacré Coeur, an undamaged hospital with 74 beds and 2 operating rooms. The massive influx of patients brought by helicopter from the earthquake zone transformed the hospital to >400 beds and 6 operating rooms. As with the 2005 Kashmir and 2008 China earthquake, most victims suffered from extremity injuries, encompassing crush injuries, lacerations, fractures, and amputations with associated dehydration and anemia. Preoperative evaluation was limited by language issues requiring a translator and included basic questions of fasting status, allergies, and coexisting conditions. Goals included adequate depth of anesthesia, while avoiding apnea/airway manipulation. These goals led to frequent use of midazolam and ketamine or regional anesthesia. Although many medications were present under various names and concentrations, the absence of a central gas supply proved troublesome. Postoperative care was limited to an 8-bed postanesthesia care unit/intensive care unit caring for patients with tetanus, diabetic ketoacidosis, pulmonary aspiration, acute renal failure due to crush, extreme anemia, sepsis, and other illnesses. Other important aspects of this journey included the professionalism of the health care personnel who prioritized patient care, adaptation to limited laboratory and radiological services, and provision of living arrangements. Although challenging from many perspectives, the experience was emotionally enriching and recalls the fundamental reasons why we selected medicine and anesthesiology as a profession.