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From pain management to Port au Prince: a doctor’s journey in disaster relief

As medical doctors, we think we can help alleviate physical suffering in almost any situation. When the 2010 earthquakes shattered Haiti’s capital, I felt compelled to help. I had extensive pain management experience and training as a physiatrist. I thought I was ideally suited to lend a hand. At the time, this all seemed obvious. But I had never been in a disaster zone before, which made me hesitant.

Still, my heart pounding, I accepted a colleague’s call for volunteers to go to Port au Prince on a humanitarian mission. I was exhilarated by the prospect of playing the hero. However, I soon learned that helping people in disaster circumstances is more complicated than I had anticipated. To begin with, I was shocked by the difficulties in just getting there. The group of doctors I traveled with and our medical supplies depended on donated private transportation to Haiti.

Moving large volumes of medical supplies is difficult most times. But when the transportation is inadequate and ten times smaller than what it should be, then things get interesting. We crammed our equipment first into a private jet belonging to a friend of one of the doctors. Then we transferred to another private jet lent to us by a random patron.

Upon arrival in Port au Prince, I soon realized how out-of-my-depth I was. I had been trained to practice medicine in a U.S. hospital setting. But here, no functional hospitals were left. Under these circumstances, I had yet to be trained to improvise or operate at a basic level. There were no options to abide by usual best practices. It dawned on me that I quickly needed to adapt so that I wouldn’t accidentally do more damage to the patients I treated.

I found that the most critical patients were those with crush injuries, of which there were many. Untreated crush injuries have a high mortality. For this reason, one of the doctors on our team had come prepared to perform field amputations en masse. He had a bone saw and intravenous acetaminophen for pain but very little else. He seemed to know what he was doing. I certainly did not.

I felt relegated to what I felt competently that I could do: administer IV acetaminophen and monitor a patient to see if they were crashing. Therefore, I volunteered to help the surgeon, holding the fully conscious patients’ hands, as my colleague amputated their dying limbs. Around us, diseases like cholera were rampant. I knew only how that would have been treated in the hospital. Fortunately, aid agencies had thought of this but needed help transporting clean water onto the island. They were struggling to stop people from drinking the contaminated water.

We gave oral rehydration solution and antibiotics to reduce mortality rates among the treated patients. However, I had to be taught to do this by field medics because it was not part of my training as a doctor. This experience was an impactful revelation of how woefully unprepared many doctors are to function outside of the particular range of circumstances in which they are taught to operate.

As doctors, we are taught to operate in the context of multidisciplinary teams. We are encouraged to specialize in knowledge, often learning little about how to treat conditions outside our range of expertise. We are taught to abide by best practices, but not when those become unavailable. We are rarely taught to improvise. Those in the medical profession should invest in intentional training in emergency field crises if they want to make a difference in helping in the world health crisis.

Otherwise, the time spent may be more about providing a warm but temporary sense of significance or, at worst, some posts on social media to broadcast their involvement. Medical degrees allow the treatment of almost any medical condition under most circumstances. But are we qualified to do so under extreme conditions? How many of us would be comfortable treating patients if our support systems broke down or if we were faced with impossibly limited supplies?

After my experience in Haiti, I also began to think about how equipped I was to handle the standard proverbial “Is there a doctor in the house?” emergencies. I don’t know how to manage a heart attack on an airplane beyond administering CPR. I don’t know how to care for a car accident victim beyond trying to stop bleeding and conducting a neurological assessment.

If we want to help in emergencies under sub-optimal circumstances, we must add field medicine to our repertoire. As the COVID-19 pandemic taught us, we cannot assume that best practices will always be available, even within our hospitals. While I was in Haiti, I found myself debilitated by overwhelming feelings of helplessness and despair. Witnessing the human tragedy around me made me question my abilities as a medical professional and face the limitations of my expertise.

In retrospect, this highlighted the need to have training in the psychological stresses of practicing medicine under these conditions. In the aftermath of our trip to Haiti, we received much credit for our volunteerism. I saw instances of some taking photographs of doctors helping patients, which were then splashed across hospital public relations pages. I know our efforts helped, but I wonder how much more impactful it could have been.

Nevertheless, genuine care and empathy when interacting with patients are transformative and have a healing effect under any circumstance. Trying to face the world’s problems can be overwhelming, but we can cope when we strive to make a difference in our given sphere of influence. But we must be willing to adopt a willingness in humility to adapt and learn if we want to expand that area of influence. We should create and improve curricula at medical schools to practice in crisis locations. We should mentally prepare for the psychological stress we will face before traveling to emergencies outside our norm, but it must be done for the right reasons and with proper preparation.

Francisco M. Torres is an interventional physiatrist specializing in diagnosing and treating patients with spine-related pain syndromes. He is certified by the American Board of Physical Medicine and Rehabilitation and the American Board of Pain Medicine and can be reached at Florida Spine Institute and Wellness

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