Richard Villar heads up Merlin's emergency surgical team in Haiti. A consultant orthopedic surgeon, Richard has extensive experience in disaster zones, having worked on Merlin’s response to the Kashmir and Jakarta earthquakes.
He wrote this field diary earlier in the week.
Yesterday was not a good day. I looked down on the elderly woman who had been laid tidily in the corner of a hotel car park and, somehow, knew that what I was doing would be futile. She was in a serious condition and in obvious pain. Her problem? Intestinal paralysis caused by a broken pelvis and shoulder; the result of being trapped under tons of rubble following the Haiti earthquake. Her treatment was simple – all she needed was nursing care, to a reasonable standard in a moderately equipped hospital. No life-saving surgery, just time and patience would cure all. Yet in Port-au-Prince so many of the hospitals have been reduced to ineffective skeletons of their former selves. Cracked wards, destroyed operating theatres, and hospital staff missing, dead or struggling to come to terms with their own loss.
My patient had nowhere to go. As I watched I could see her abdomen visibly distend, so tender that even a gentle touch caused her to scream in agony. I placed my ear gently against her swollen belly. There were no sounds of bowel activity, a sure sign that her blood chemistry would be wildly altered and that this would be the problem that would kill her. I talked with her daughters, quietly, in the best French I could muster. “Your mother will die,” I said, “unless we can find proper nursing care in a hospital who can look after her.” Clearly they were distressed, tears flooding down their faces, although I was telling them what they already knew. There was nowhere for their mother to go. Only good fortune would allow her to survive.
This is Haiti less than one week after the most massive earthquake for, I have been told, 200 years. The hospitals are either broken or full, surgical and medical teams working round the clock in corridors, on landings, on the hospital steps, even in the car parks. Drugs and medicines are running out, single-use instruments being reused in sequential patients, gloves used for multiple cases, while amputations are performed in their hundreds on kitchen tables.
I had to move on, this time to the region of Delmas in the centre of town. Our driver valiantly battled the crowded streets, swerving heavily to avoid earthquake rubble, dead bodies that even now lie unrecovered, and other drivers in panic. His hand was never far from the horn: a safety measure but also perhaps a chance to give sound to his own silent mourning for his 40-year-old brother who had been crushed to death with tens of thousands of others only days earlier.
This should not happen. Not now, not here, not in 2010. The massive, American-driven aid machine is throwing its might against a problem that is almost unsolvable. Even as the casualty toll mounts, available food, water and petrol declines. I lay awake most of last night listening to the airlift taking place. Huge aircraft fill the sky. Helicopters take off and land. Ambulance sirens wail, taking their patients to heaven knows where. The locals become restless, with occasional riots, while UN soldiers cover their every move with rifles and machine guns at the ready. This is disaster at its worst.
We had to move clinic location today because the smell of the rotting bodies of children from the crushed school beside us is now making work impossible. As of tomorrow I take up residence on a former tennis court, the patient waiting area being the spectator stands, the hospital being tents provided by Merlin who responded in double quick time to this most horrendous of disasters. It is hot, water is fast disappearing, and the locals are quite rightly at times very, very restless. “Can we have food?”, they ask, “When will you rebuild my house?” I explain that I am a doctor, a surgeon, that my skills are totally medical. They look unconvinced, at times aggressive, as if I am personally to blame. Perhaps I am, perhaps I am giving these helpless, charming people unreasonable expectations of what I can offer. Perhaps, when my Merlin colleagues from England arrive tomorrow - a 12-stong surgical team and expert logistics people who have decades of collective experience in emergencies - the situation will be different. I hope so. Things can only be better. I cannot see how they can be any worse.
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