Saving Lives Onboard the USNS Comfort

Dr. Paul Firth Offers an Eye-Opening Description of the Life of a Medical Volunteer in Haiti

My name is Paul Firth. I am a pediatric anesthesiologist from Boston. I work at the Massachusetts General Hospital, the Massachusetts Eye and Ear Infirmary, and the Shriner Pediatric Burns Hospital. Pediatric anesthesia is the speciality involved in delivering anesthesia to children for surgical operations, and the care of critically ill children. As children have quite different anatomy and physiology to adults, the technical skill set is narrow and specialized. Useful person skills include a cheerful outlook, relating well with children, intense focus, and the ability to perform effectively in highly stressful situations.

A hospital administrator called me in the operating room the morning after the earthquake to ask me if I could fly to Haiti the next day. The Haitian earthquake disaster involved many children, since impoverished economically developing countries have a far larger proportion of the population under eighteen than do the wealthy developed countries with static population growth. I said “yes” without hesitation – my skill set was essential to helping these people. I called my wife – we have three young children and she would be left alone with them for weeks. She too said yes immediately – “You have the skills – you must go.”

Enthusiasm and commitment is one thing – actually delivering effective care is another. The hospital coordinated with Project Hope to send a team of volunteers with highly specific skills to augment the Navy’s hospital ship, the USNS Comfort. As a floating hospital with a primary aim of treating wounded soldiers, it is not specifically fitted to look after large numbers of children. Our team was loaded with various pediatric specialists. We flew out two weeks after the earthquake on a mission to save limbs and lives – treating secondary infections that would lead to amputations, or, if unchecked, to a second wave of deaths.

We flew to Jacksonville, FL. Here we were flown in a Navy transport plane, arriving in Port-au-Prince airport late afternoon. We were just one small cargo in a flood of men and materials – enormous military cargo planes arrived every few minutes, disgorging massive deliveries of people and supplies onto the tarmac. It was an awe-inspiring spectacle to witness. People were going the other way too – we saw Haitian earthquake victims being airlifted to the U.S.

We moved through the bustle along the tarmac to where helicopters would transport us to the Comfort. We had arrived too late for our entire team of 30 people to get out to the ship – dusk was falling, and half of our group was left on the ground in the gathering gloom. The local military teams took us under their wing, and slept the night in cots in the open – surprisingly comfortable. We were also introduced to the military delicacy known as MRE – ‘meal ready to eat’ – that works extremely well if, as we were, you are extremely hungry and have no other options.

We had a heart-warming experience at the airport. Renold, a radiology technician and one of our team from the Massachusetts General Hospital, is Haitian. His mother is 78, and her house was damaged in the earthquake, but except for a trvial scratch on her knee, she was unharmed. She made it to the airport and through the security cordon, and was reunited briefly with her happy son. She had been staying with relatives since the earthquake. We were introduced to the toughness of the Haitians – this frail looking lady apologized for her appearance, having been sleeping in the open for two weeks since the family was too afraid to sleep indoors!

We were up before sunrise for our dawn Navy helicopter trip. We lifted up and were flown onto the flight deck of the Comfort. A converted oil tanker, the ship is huge, only slightly smaller than an aircraft carrier. Below the flight deck is an administrative deck, then a deck containing the casualty receiving area, the operating rooms and the intensive care units, below that decks containing the wards, and finally in the hull, the sleeping quarters for the crew.

The crew was very welcoming, despite clearly being extremely busy. Our team included pediatric and adult ICU nurses, which allowed the hospital to immediately expand the number of intensive care beds. We also had a specialist wound care doctor, a pediatrician, a pediatric emergency medicine doctor and a pediatric intensivist. We had a shower to wash the Deet and the tarmac dust from our skin, then breakfast at 11 o’clock. We were told to leave our luggage in the corridor while they tried to find us a bed for the night, and started working before noon. I began helping to anesthetize children, and didn’t stop work until 10 that night.

Many of the patients were there for fractured and infected limbs. Some of the cases were wrenching – impossibly broken and infected arms, legs. But for every irretrievable case, there was an amazing case – a limb hanging by a thread for more than two weeks that was somehow still viable. Horrible terse notes in referral letters – “pulled from the school rubble – fathers presence unknown” – but also happy discoveries that wound were not as severe as expected.

My first day saw also a case I had never encounters before – a severe case of tetanus. There had been three cases in the previous days – one child died, another was in the intensive care on the ship fighting for life on a breathing machine, a third also intubated and airlifted to Florida. Tetanus is a toxin released from an infection that follows often minor wounds, and, if not treated, is usually fatal. Treatment involves cutting out the infected area and a large margin around it – the extent of the surgery meaning that anesthesia is invariably needed. If a breathing tube is put in the throat to deliver anesthesia, as in the previous two cases, the severe muscle spasm of tetanus can make it very hard to pull the tube out at the end of surgery. A prolonged course on a breathing machine not only poses severe risk of causing fatal pneumonia, but also consumes precious staff resources to look after the patient. We were able to anesthetize the patient without a breathing tube, despite his severe muscle spasm. He avoided a breathing machine and was doing well the day following his surgery. The next day I was involved in a second case of tetanus, again managed the same way.

Late that night I picked up my bag from the corridor and was shown to my bunk on the bottom deck of the ship. It was towards the aft or rear of the ship. After two and a half days of travel and a long a difficult day, I was ready for sleep.

At 4:30 am I was woken from a deep sleep by an overhead page: “Code Blue in ICU 3, code blue in ICU 3!” This meant someone was dying in the ICU. Typically there should be an anesthesia team assigned to cover emergencies such as this, but I did not know if the hospital had organized this in the midst of the crisis. In my sleepy brain, I realized that my colleagues had been working flat out for days and were probably exhausted. Since there were so many children on the ship, the person dying might well be a child. I rolled out of bed, put on my shoes, sprinted up eight flights of stairs and pounded along the length of the ship to the ICU. There was a baby who was struggling to breath and the staff was having difficulty getting a breathing tube into his throat to assist his breathing. I was able to put in the tube and revive his blood oxygen levels. It was a long run from the lower deck at the back of the ship to the ICU at the stern. I’ve run about 25 marathons and ultra-marathons in the past, but probably this was one of the more important races in my life.

It remains very busy. Everyone is extremely tired. We hope to get another 17 anesthesiologists and anesthesia nurses, and a further 10 orthopedic surgeons, as reinforcements next week. Until then we will keep helping the relentless flood of critically ill earthquake survivors.

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