ISN Announcements
Haiti earthquake: update from ISN Renal Disaster Relief Task Force
2nd Communication Report by R. Vanholder-ISN Renal Disaster Relief Task Force (RDRTF)
January 18, 2010
The first part of the assessment team of the Renal Disaster Relief Task Force of the International Society of Nephrology (ISN/RDRTF), a doctor, R. Caluwe and a nurse, S. Claus reached Santo Domingo (Dominican Republic, DR) in the evening of January 15 (local time) where they were welcomed by Dr. S. Rodriguez, President of the Dominican Society of Nephrology. They immediately continued by car in the direction of Port-au-Prince, Haiti, where they arrived the same night; they started their mission immediately the day after. Two days later two other members of the team reached Port-au-Prince (a renal nurse, S. Maddens, and a dialysis technician, P. Stockman). Our team was incorporated in a large group of rescuers from Médecins Sans Frontières (MSF) which in total is composed of some 100 people.
All members of the team carried light material in their hand luggage (e.g. Kayexalate and dialysis catheters). A cargo with heavy material (4 dialysis machines, an inflatable hospital) left Europe already on January 16, but the carrying could not land in Haiti. The material was rerouted to Santo Domingo, DR, from where it was shipped to Port-au-Prince on smaller planes. The material reached there on January 17 in the evening. The problem is however to unload and transport the material within the city.
The team has been confronted with serious communication problems, whereby only sporadic contacts can be held by satellite phone (early morning, local time) and email (late evening, local time). No contact is up to now possible by mobile phone.
The situation with which our team is faced is dramatic. Most wounded people are lying in the streets without care, although the situation is improving (or rather is not as bad as at the beginning). All local hospitals are overcrowded. There is a shortage of all kinds of medical material including drugs, as well as of water and electricity. Identification, triage and transport of victims with potential crush are hard to organize.
Our team found a hospital with three intact dialysis machines, the General (University) Hospital, which were no more used - all chronic patients had apparently left when the earthquake occurred and did not return. To the best of our knowledge, this is the only potentially operative dialysis unit in the city. The building had first to be declared safe. The planning was to make the unit operational before the evening of January 17, then adding our own four machines. MSF would generate its own water and electricity. The whole process was unfortunately delayed due to chaos. The three Haitian machines could not be made operational as some material was locked in closets, whereas the local nephrologists could not be reached to open these. Also bringing our own cargo to Port-au-Prince was seriously delayed, and once it arrived, there arose problems with transport and unloading.
All in all, we hope to start dialysis tomorrow, Tuesday, January 19, if not today. As long as they do not perform dialysis, our team offers substantial help in primary care (fluid administration, bandages and vaccinations). In the meanwhile also, a search is made in the hospitals and the city for potential risk patients and advice is given for proper fluid administration. Although the team carries its own material for lab determination (dry chemistry), this turned out difficult in the ambient temperature conditions. This has now improved, since determinations can be made in an appropriate room, no more outside in the streets.
It has appeared that victims started to flow into the Dominican Republic where the government decided to give all support needed to any Haitian person with health problems. This occurred first in some border cities. Via Drs. R. Correa-Rotter (Mexico) and A. Hurtado (Peru, Latin-American RDRTF representative), we stayed in close contact with Dr. S. Rodriguez from the Dominican Republic. It was decided by MSF to send one of their doctors (L. Verhenne) to the Dominican Republic to offer support to the local medical staff. She is due to arrive this evening (January 18). Since we were informed of a shortage of dialysis material in the near future, Dr. L. Verhenne will carry dialysis catheters and heparin with her in her hand luggage. More bulky material will be sent in a new cargo on Thursday.
All the time, we also stayed in close contact with Dr. D. Portilla, coordinator of the Disaster Task Force of ASN.
A preliminary draft of the ISN-RDRTF recommendations on crush was distributed to Spanish colleagues for perusal in the Dominican Republich. An abbreviated version was made with the essentials and translated in Spanish by a group of Latin-American nephrologists coordinated by Dr. R. Correa-Rotter. A pamphlet has also been sent in English, Spanish and French, on early fluid management of candidates for crush syndrome.
We are now preparing a second team, composed by one volunteer nephrologist (Dr. J. Vanmassenhove, Belgium) and two renal nurses (N. Eyhartz and D. Borniche, France).
It goes without saying that these are the most extreme disaster conditions we have ever been faced with during the existence of the ISN-RDRTF. Fortunately, we can rely on the excellent logistic support of MSF. We also are grateful for all the help and support we received from colleagues from all over the world. But structural chaos together with a disaster of unseen dimensions makes progress extremely difficult. Nevertheless, all these tiny acts of support together will help to save at the end a substantial number of lives.
Ray Vanholder,
Coordinator IISN/RDRTF
Read the first report of the ISN-RDRTF, January 14, 2010
More information on the ISN-RDRTF
Coordination Center
Raymond Vanholder, Chairman ISN/RDRTF
Assistant: Chantal Bergen
General e-mail address ISN/RDRTF: RDRTF@ugent.be
Nephrology Section MCA, University Hospital Ghent
De Pintelaan 185, BE-9000 Ghent, Belgium
Phone +32 9 3324522 - Fax +32 9 3324599
