Improving Orthopaedic Care Delivery at a Referral Hospital in Haiti: The Legacy of the 2010 Earthquake

SAN FRANCISCO—In the second session regarding national disasters, authors will report the findings of a study on the long-term positive effects of international orthopedic assistance during and immediately following the Earthquake in Haiti.

Investigators reviewed operating room records at a hospital approximately one hour outside of Port au Prince, the epicenter of the earthquake, during the 16 weeks that preceded the Haitian earthquake in 2010, as well as patient records from the 15 weeks that followed, to compare patient procedures and care.

“With any kind of disaster, especially an earthquake-related disaster, there’s going to be a lot of orthopedic injuries,” said lead investigator Charles S. Day, MD, MBA, chief of the Division of Hand and Upper Extremity Surgery in the Department of Orthopaedic Surgery at Beth Israel Deaconess Medical Center in Boston, and Associate Professor of Orthopaedics at Harvard Medical School. “The number of major orthopedic procedures jumped from 10 to 455 immediately following the earthquake.”

In the disaster response to the earthquake, visiting orthopedic surgeons aided and trained the Haitian surgeons in a broad range of techniques and care. These clinicians are now “providing orthopedic care for the local community; care that wasn’t available before the earthquake. We were able to provide care, and impact future care in that region.”

Additionally, the authors report:

• During the 31-week study period, 465 orthopedic surgeries were performed (2% pre-earthquake and 98% post-earthquake).

• After the quake, only 10% of the orthopedic surgeries were amputations.
• Patients treated after the earthquake were significantly older than patients treated prior to the earthquake (average age 61 versus 25 years).
• There also were significantly fewer patients diagnosed with gangrene (due to lack of blood flow to an extremity) post-earthquake (5.3% post earthquake versus 60% pre-earthquake).

Prior to the earthquake, the only orthopedic surgeries conducted at this hospital were amputations, said investigator Thierry Pauyo, MD, a resident at McGill University. "In the developing world, manual labor is for the majority of people the only way to survive. Amputation as the sole treatment for musculoskeletal injury is simply unacceptable. If you lose a limb, you can't work; it affects the entire family you are providing for."

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