January 22 2010

Richard Villar heads up Merlin's emergency surgical team in Haiti. Here, he writes about his experience treating victims of the earthquake.

He wrote this, his second field diary, earlier in the week.

I cannot explain how I can feel happy when looking at the infected, stagnant mess of a young child’s amputated foot. Yet strangely, in my clinic today, I did. It was not the foot of course, but the face. The child smiled, his four-year-old eyes bright as buttons. They said to me, “I have a future.” For a brief moment the eyes dulled when he screamed in pain as I tried gently to remove the dressing from his infected stump. Yet the pain soon settled and the smile returned, as the wound was irrigated clean. Yes, I thought, the first shoots of recovery are beginning to appear in Haiti.

Say what you like about failings in security or co-ordination, as well as delays in the provision of aid. For those of us in the field, these things drive us crazy too. I am luckier than most as the organization for which I’m working, Merlin, is widely known and has been dealing with disasters for more years than many can remember. However, despite any failings of an aid effort such as this, everywhere I begin to see tiny signs of recovery. Slowly the rubble is beginning to clear, slowly the frightened many are returning to work, and slowly new alliances are being forged. The resilience of humanity is remarkable. We, Merlin that is, are helping where we can. This morning, as well as running the clinic, we employed 40 local people to help reinforce the fragmented walls around the tennis court where I now work. I had to restrain a chuckle as I listened to our magnificent logistician, Andrew, bargain hard but diplomatically with a group of laborers. They spoke Creole, he spoke French, but somehow they reached a point where everyone was happy. There was much laughing, shoulder slapping and gentle punches, and the group then set to work.

The clinic was chaotic today, patients jostling and queue-barging, everyone insisting they had to be first. The man whose head is still leaking cerebrospinal fluid from his skull fracture, the boy with the massive tumour in his neck, the child with the broken shoulder which has lain undiagnosed so far, the elderly lady with the broken sternum or breastbone and for whom every breath was agony. She had lain trapped for three days before rescue. Then there is the young girl with frequent blackouts since the earthquake who is claiming that a rock fell on her head at the time. I could find no evidence of damage, although that did not surprise me. This was manifestly post-traumatic stress, not the sole domain of the soldier. As a surgeon, I am unable to concentrate on any one task for long, as the moment I do, a hand touches me gently on the elbow to direct my attention to the next poor individual who has made their way to our clinic. The pattern of injury is now beginning to change. In the early days after the earthquake there were amputations by the hundred, head injuries and fractures. Now I am seeing many, many infections while tetanus, the scourge of contaminated wounds, has today arrived in Haiti.

Meanwhile, yet more Haitians came to ask if I could employ them: a psychologist, a medical student, a taxi driver, each wanting to do their bit in their nation’s recovery. Despite my optimism, the total destruction of so many businesses means that large numbers of people must start life again. Everyone has been affected. However, today, a number of stories of true heroism emerged. The man who held up a wall so his family could escape, before the collapsing property crushed him dead. The husband who was forced to take a machete to his wife’s foot, to release her from beneath massive rubble. How would any of us react in such a circumstance? Not with such prompt courage, I would wager.

The aid effort has most certainly swung into action. I have been to more disasters and wars than many but have never seen anything like this. Line upon line of United Nations vehicles, wave upon wave of aircraft, row upon row of personnel. I feel so tiny and at times so ineffective. Each time I revisit the United Nations base, its population appears to have quadrupled. One can only hope that with such an increase in number will come an increase in efficiency. Yet whatever is said, I do feel privileged to form part of this, to know that this is a truly international effort – Turkish policemen, Croatian soldiers, American mortuary attendants, Czechoslovak map-makers, Brazilian security guards. We’re in and we’re working, that is without doubt the main thing.

Today is a very good day, however, as our second phase, full surgical team has now arrived, somewhat beaten and bruised after their long road journey from the Dominican Republic. With them come some old friends and new acquaintances. Frustratingly, the team’s equipment is still at the border. What do I tell the patients tomorrow, each of whom has been promised an operation then, or the next day? How can I say that their procedure has been postponed once more simply because the instruments they need simply can’t get through? I hear the equipment will arrive by 7.30am so maybe, just maybe, all will be well. For now, it is time for bed.

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