Thursday, February 04, 2010
"We worked until we collapsed"
A doctor with the Israeli delegation tells ISRAEL21c what it was like to try to save as many lives as possible in Haiti, after the devastating earthquake. An unexpected call up: Dr. Ian Miskin, an infectious disease specialist, joined the Israeli delegation to Haiti in the wake of the earthquake.
Dr. Ian Miskin, one of Israel's foremost infectious disease specialists, admits it will take time for him to fully internalize his experiences in post-earthquake Haiti. For two weeks he was totally immersed in aiding rescue missions and treating survivors rescued from the rubble.There were some uplifting experiences, he says, such as when he helped to treat a child who had been rescued after being trapped under debris for a full week, but he also witnessed many deaths. It was like nothing he had seen before.
"It was an unexpected call-up," the 53-year-old British-born doctor, who has lived in Israel since age 14, tells ISRAEL21c "A colleague in infectious diseases asked if I wanted to go. I called my wife [who is a pediatrician] and she said yes, so I went. Within two hours I was on the list. We met at five o'clock that evening at Tel Hashomer Hospital for a briefing, then I went home to prepare and early the following morning turned up with two weeks' worth of clothes. We all had [immunization] shots, heard a lecture about the situation and were briefed about the operation."
Miskin, who spends about a month each year in uniform as an Israel Defense Forces (IDF) doctor in the reserves, knew only two members of the delegation beforehand. "We were introduced to each other then got to work. Eighty percent were soldiers serving in the standing army. I was one of about a dozen reservists. Somehow, within 24 hours all the equipment was loaded on a jumbo for the long flight. By the time we arrived at the airport, we were really tired."
The 200-strong team used the 16-hour flight on an El Al plane to recharge its batteries. "The first-class section was set aside for sleeping. We originally planned to fly to Santa Domingo - only two hours out we learned that we could land in Port-au-Prince."
Working till they dropped
On arrival, they rapidly set up camp in a soccer field not far from the airport. "We had no food, and made a kabalat Shabbat [Jewish ritual for welcoming the Sabbath with bread and wine] with two pitas and a glass of grape juice. We went to sleep at seven then were woken at midnight to unload the jumbo, which had just arrived. By 10:30 the following morning the first patient arrived - there was no time for an opening ceremony. From that point on, we worked non-stop, at full capacity."
According to Miskin, on a professional level, the team learned much from the experience. "We made plans in advance - some worked out, some didn't. To set up a field hospital was the correct decision. It was the only one in Haiti for five days. We also had a pretty sophisticated patient identification system - each patient was photographed on arrival and had an electronic record of his treatment that went with him."
Miskin has nothing but praise for his colleagues. "They wouldn't set a time when they would finish their shifts - they just worked until they collapsed. We had 40 doctors, 20 nurses and 20 medics and paramedics with us. People were doing things that weren't their job - when the eye doctor finished treating his patients he manned the gate. Everyone helped each other. People were looking out for each other all the time, seeing who needs help."
There is still much work for international aid missions to do in Haiti, Miskin says, adding that there is a growing problem of infections among survivors, which often lead to endemics and widespread diarrhea.
"There are still a huge number of maimed people out there - everything was infected. People who were severely crushed often died because their kidneys packed in - there was nothing we could do. Those who had wounds on their torsos died."
Who decides who lives or dies
"On the last day we were working, the Monday, we saw 150 patients. We closed at 4pm, but then, after the last patient had already been admitted, a little girl came up. She was given a local anesthetic and we operated on her."
The medical staff found itself confronted with issues of medical ethics. "Obviously, we had a problem that we couldn't treat everyone, and someone had to make life-and-death decisions. Because we thought it was important, we set up ad-hoc, three-doctor ethics committees. Nobody else foresaw the problem - it was something we found we had to do. It's something that only Israelis would think of - doing it together."
The mission worked in less-than-ideal conditions. "The scary part was the first days - we had almost nothing to eat, no shower, no way to sleep properly. We slept in pup tents, but it was so hot and humid, so damp. Everything you left outside was soaked... our electricians set up satellite telephone lines to Israel so that we could call home, but because of the work load, we often didn't have five free minutes to call home."
He notes the importance that was attached to maintaining the team's health - both physical and psychological, so that its members would have the strength to give their all. "We had a psychiatrist and psychologist with us - we all needed that help. There was a huge amount of stress - and remember, many of the group were 20-year-olds. We just worked until we dropped. I've never seen anything like it. There was a huge amount of pressure on every member of staff."
The team's commanders insisted that their charges take time off. "Three hours in the shade on the beach - everyone went there once. There was even a list to make sure that everyone went. Rest is important. Also, everyone went out into the city at least once to see what was going on.
Israelis first on the scene
"It was very hard work. In time, we were joined by a Colombian surgery theater, working side-by-side. They also worked their asses off. The Colombians were terrific. They brought us drugs and equipment we'd run short of, such as a blood analyzer. A group of Canadian nurses also helped, and there were some Haitians who spoke Creole. I used my basic French to communicate with patients. The American civilian hospital also took a little of the load off us," says Miskin.
The Israeli response to the crisis received a tremendous amount of praise, which some commentators described as "disproportionate." Miskin responds drily: "The advantage of the Israeli delegation was that we got there first. Haiti is the poorest country in the western world. All the buildings collapsed, and there was rubble everywhere. That's what you're starting from.
"The operation was so well organized because it's the army, which can muster people within hours. Every morning at seven we held a morning parade. There were 30 majors, 10 lieutenant colonels and three full colonels in the team - but that didn't matter."