Life on the Line 

With 2,700 volunteers, massive donations, and a 24-hour command center, the UM Global Institute and Project Medishare manage to save thousands during a worst-case-scenario natural disaster.

The first wave of doctors landed at Port-au-Prince’s ruined airport the day after the earthquake with only garbage bags full of sutures, antibiotics, and wound dressings—whatever they could grab before their flight. But what they faced when they disembarked would have overwhelmed them even if they’d had a week instead of mere hours to prepare.

Dean Isaac Prilleltensky and EtionyAldarondo

Neurosurgeon Barth Green, kneeling, fights to save lives while staying focused on Haiti's long-term prognosis.

“The first thing that crossed my mind was that I had landed in hell,” recounts Barth Green, professor and chair of the Miller School of Medicine’s Department of Neurological Surgery who frantically organized a small medical team to go to Haiti the morning after the earthquake struck just before 5 p.m. on January 12.

As co-founder of the humanitarian effort Project Medishare, a University of Miami sister organization, Green had been helping to make health care more accessible to the people of Haiti since 1994. But the country he knew so well was now alien to him, a horizon of rubble and debris. Green’s connections had enabled him access to Haiti faster than any other foreign emergency responder. As a result, UM found itself, naturally and instinctually, at the forefront of the global medical response to the ravaged country.

After landing, Green and his team—trauma surgeon Enrique Ginzburg, co-director of neuroscience intensive care and medical director of UHealth International; Edgar Pierre, a Haitian trauma anesthesiologist and assistant professor; surgical critical care fellow Daniel Pust; and physician’s assistant Leo Harris—were rushed to two United Nations cargo tents wedged by the side of an airport access road. Inside were hundreds of Haitians with multiple fractures and crush injuries, along with deep lacerations complicated by a host of other factors. The space was crowded and chaotic.

“It was like a war zone. There was crying, screaming,” Ginzburg said only days later, while making his rounds of patients at the field hospital. He says he slept a total of ten hours those first five days.

Initially they performed operations on folding picnic tables, sanitized and covered in sheets, then set up outside so the blood would wash into a gutter and not contaminate the floor on which hundreds of people walked.

“I was really shaken to see all these people hemorrhaging,” Green recalls. “I kept wanting to say, ‘I’m sorry, so sorry, for what happened.’ But it didn’t matter what I said. It was an emotional tsunami. And then I got to work….”

Doctors used local anesthesia and relied on old-fashioned visual and hands-on examinations to diagnose injuries. Meanwhile, out in Port-au- Prince, many of the injured were waiting for rescue from the rubble-clogged streets. As a result, their wounds quickly turned gangrenous. Cutting off the infected body part was often the only way to save the patient. Gregory Zych, chief of orthopedic trauma at the Miller School, arrived days after the earthquake, succeeding Ginzburg as chief medical officer. Within the first week at the U.N. hospital, he says, surgeons had performed roughly 200 operations, many amputations. “That’s more than most orthopedic surgeons perform in their lifetime,” Zych noted at the time, standing outside the operating tent in his scrubs, looking exhausted.

But the Miller School/Medishare effort in Haiti had something going for it: organization. As soon as Green’s plane took off for Haiti that Wednesday morning, an impromptu task force established a Miami-based command center in the small library next to his office. Its volunteer staff remained in constant contact with medical personnel in Haiti, who were able to tell them exactly what they needed. The volunteers then set about procuring supplies, organizing flights, and recruiting doctors and nurses, particularly those skilled in specialties targeted to the disaster’s aftermath such as infectious disease, orthopedics, and anesthesiology.

Dean Isaac Prilleltensky and EtionyAldarondo

Within two weeks UM had a critical care hospital in Haiti.

A Miller School account of the response published in March by The New England Journal of Medicine explains that such rapid action allowed “425 severely injured, immobile survivors” to be treated within the first week. “For the first 48 hours,” the article continues, “intravenous hydration, wound dressings, orthopedic splints, tetanus toxoid, and narcotic analgesics will stabilize most injured patients whose lives can be saved.”

Even before the earthquake, Green had asked a fourth-year medical student and Project Medishare volunteer named Elizabeth Greig, M.D. ’10, to study and write up a trauma and disaster management plan for Haiti.

Dean Isaac Prilleltensky and EtionyAldarondo

Clockwise from left, a Martinique doctor confers with Miller School of Medicine physicians Edgar Pierre and Daniel Pust as medical director Enrique Ginzburg amputates a foot outside of the U.N. clinic. Previous page, from top: A volunteer nurse from California tends to a survivor. Ali Aserlind, a Coral Gables volunteer, feeds a newborn.

“There was no trauma center in Portau- Prince,” Greig says. “No burn unit. If someone gets sick in Haiti they essentially have to be flown out of the country. There’s a saying in Haiti: ‘When in pain, get on a plane.’ But that’s only for people who can afford it.”

In the months before the quake, Green delivered Greig’s plan to Haiti’s Ministry of Health, where it had been given initial approval. Seed money was raised from private donors. “The weekend of the earthquake we were just about to start training in Port-au- Prince,” Greig notes.

As doctors struggled to stem infections and keep up with the immediate flood of patients in the face of catastrophe, Green and Ginzburg knew they needed a larger facility. With help from former Miami Heat star and philanthropist Alonzo Mourning, who solicited help from throughout the NBA, money was raised to buy and quickly deliver four big tents and medical equipment. The family of Leonard M. Miller, for whom the medical school is named, subsidized airlifts to and from Haiti and donated 50 satellite phones to enable emergency communications. On January 21, UM opened a 240-bed, air-conditioned hospital at the edge of the Port-au-Prince airport, equipped with X-ray machines, four operating rooms, sleeping quarters for volunteers, and plywood floors. Some 2,700 medical personnel from the UM community and beyond—nearly every U.S. state and several countries—would volunteer to take shifts at the hospital.

As director of the facility, Ginzburg has been back to Haiti numerous times and monitors daily operations, which have moved out of the tents and into a fixed facility. “The tent hospital, at its peak, was serving 400 patients a day in the emergency triage center and performing up to 30 surgical procedures a day with a staff of over 250 international and U.S. volunteers,” Ginzburg says. “During its existence, it treated close to 30,000 patients and performed more than 1,500 surgeries.”

Dean Isaac Prilleltensky and EtionyAldarondo

The command center at the Miller School of Medicine tracks what’s needed on the ground in Haiti and then gets it there.

Occupying a building at the Miller School of Medicine, the command center continues to maintain communications and coordinate logistics with the relocated hospital in Haiti. “We’re staffing a hospital with a new staff every week,” James Vermillion, a volunteer chief administrator and retired U.S. Agency for International Development official who spent many years in Haiti, explained earlier this year. Initiated by Haiti Relief Task Force volunteers, the center has been run since January 25 by the UM Global Institute for Community Health and Development.

The Haitian Government estimates that more than 300,000 died after the quake, but with uncounted bodies in mass graves as far west as Petit Goave and Jacmel, there’s no way to know how many really perished. More than a million Haitians— one-tenth of the population—were displaced, according to U.S. government estimates. Economists forecast damages in the range of $8 billion to $13 billion for Haiti, a country whose GDP is only $11.6 billion. And the country’s health care infrastructure, already scant before the quake, is decimated. Recovering, rebuilding, and just surviving will be a challenge for the foreseeable future, especially with the arrival of heavy rains and the hurricane season.

Amid the devastation, though, plans are under way to transform Haiti’s health care system. Although “silver lining” is too optimistic a phrase to accompany such a calamity, Project Medishare’s plan for a national trauma system is on the fast track given the sudden global focus on the Caribbean nation. “I think it would have taken us five to ten years to do it without the earthquake,” Green says. “Now it’s going to take five to ten months. It’s in hyperspace. There’s no doubt there’s an opportunity and there are billions of dollars out there. We just have to fight all the people who want to get rich off of Haiti.”

The UM hospital in Haiti that helped save so many lives in the short-term is still serving trauma patients and has also become a rehabilitation center, complete with a prosthetic and orthotic lab, for some of the nation’s thousands of new amputees. The plan is to build throughout the rest of the country a supporting network of hospitals, run along the lines of a public health trust. With several suitable sites identified by the Haitian government, Project Medishare is raising money for the construction.

Green says it was the dream of improving medical care in Haiti that sustained him through the shock of those first days. “When I finally came up for air, I took a deep breath and smelled the stench of rotting flesh everywhere, and I just broke down,” he admits. “But then I said to myself, you just can’t take this in any other way than as an opportunity to do something permanent and special. And that’s sort of how I kept going.”

Tristram Korten is a freelance journalist based in Miami Beach.