ISN Announcements
Haiti earthquake: 3rd report of the ISN Renal Disaster Relief Task Force
3rd Communication Report of R. Vanholder, Chairman of ISN Renal Disaster Relief Task Force (RDRTF)
22 January 2010
The first team of the ISN Renal Disaster Relief Task Force (RDRTF) arrived in Haiti via the Dominican Republic (DR) on January 16-17 and consisted of a nephrologist (R. Caluwé, Belgium), two renal nurses (S. Claus and S. Maddens, Belgium) and one dialysis technician (P. Stockman, Belgium). Their main tasks were the assessment of the local conditions, the installment of a functional dialysis unit (if possible) and the screening for Acute Kidney Injury (AKI).
Although it appeared soon that it was likely that some victims would have crush syndrome, the conditions to get everything started were extremely difficult: complete chaos, lack of existing infrastructure, lack of communication possibilities, and logistic problems to get material on the spot. Contacts with the coordination center were and still are scanty, and only by satellite phone and email (the latter being time consuming, especially for the volunteers on the spot who have lots of work).
Our team found an intact dialysis unit (3 machines) at the University Hospital but they had to wait for the building to be declared safe. There was also some delay in obtaining access to the local reserves (tubings etc) which were stored behind locked doors to which nobody around seemed to have access. The team should also have had available 4 additional dialysis machines that had been sent immediately after the earthquake by the RDRTF and Médecins Sans Frontières (MSF) on a cargo to Haiti. Delay to obtain that material occurred due to the cargo being rerouted to DR, then being subsequently refused landing in Port-au-Prince three more times. There was another lag time before the material was cleared at Port-au-Prince airport.
As a consequence, the dialysis unit became operational only on January 18, based on the local Haitian machines, with the own dialysis machines only being available on January 21. The team now has 6 dialysis machines working (a 7th has technical problems but repair pieces are being sent today with a new team of the ISN-RDRTF.
In the meanwhile, 15 dialysed patients with AKI have been dialysed or are still dialysed in Port-au-Prince. These are largely in our own unit with two of them on the American Hospital ship, HSS Comfort. A third unit is operational, in Hôpital Sacré Coeur, somewhat outside Port-au-Prince, but for the moment this unit takes in charge essentially chronic patients. There have now been retrieved some 10-15 of the originally 100 Haitian chronic patients. Some of those went abroad (Martinique). Our dialysis activities occur in close collaboration with 4 Haitian nephrologists, Drs. Buteau, Metayer, Joseph, Eliana.
Part of the AKI patients also appeared in the DR. We are aware of about 10 dialyzed patients. At least one is pediatric. One AKI patient went to Miami, USA.
Screening remains a difficult problem. Fortunately we have a dry chemistry device that allows on the spot measurement of creatinine and potassium. Local laboratorium possibilities are absent. Not everyone can be tested. Selection occurs on clinical status. Our team has been checking first large, then small hospitals. The yield of AKI remains low, partly because the screening was difficult to set up in the beginning, partly because dialysis possibilities started only after several days, partly because AKI could be prevented by fluids in a substantial number of patients (more than those needing dialysis) and finally because the structure of many houses was light reducing risks of crush.
What is feared now is a second wave due to infection and sepsis, and we are now preparing for that.
We have prepared two more teams:
* the first one is composed of one nephrologist (J. Van Massenhove, Belgium), and two renal nurses (D. Borniche, N .Eyhartz, France). This team has already arrived on the spot and has started its activities.
* The next team is composed of one intensivist (N. Gibney, Canada), two renal nurses (V. De Preester, M. Struelens, Belgium) and one dialysis technician (JP. Garcia-Perez, France). The latter team will, apart from the technician, concentrate on screening and infectious cases. They left on Friday 22 January.
Further cargo was shipped by MSF containing amongst many other items also dialysis material for both DR and Haiti.
During the whole period we were in close contact with our colleagues from the American Society of Nephrology (ASN: D. Portilla) and of the Latin American Society of Nephrology (SLANH: R. Correa-Rotter, A. Hurtado, E. Burdmann). ASN sent a cargo with dialysis material to Port-au-Prince, and a machine for dry chemistry for Dr. B. Jaar (USA-ASN) is now in the border area of DR with Haiti to screen for renal failure. SLANH will support these screening activities by financing. Several Latin-American Societies of Nephrology are preparing rescue teams, among which Brazil and Puerto Rico are the most advanced.
The next challenge will be to cope with a second wave of AKI due to sepsis and anticipate enough personnel. While maintaining the nephrologic activities, this will probably necessitate the deployment of extra teams, more focused on intensive care and infection.
We would like to discourage spontaneous and disorganized actions. Although done with the best of intentions, they may be useless for the local people and include some dangers, either life threats for those undertaking these actions solo, or ecologic risks for these poor and seriously affected countries. There may be also a ceiling in the number of rescue workers that the country can take. Even if it would be possible to make enter more people to help in this huge task, it remains a major issue to sustain all these people (food, water, shelter) in their day to day needs in an extremely poor country, and this is another major challenge with which most rescue teams are confronted.
Circumstances are still very fierce; the infrastructure remains insufficient, and many people are lost who under better conditions would have survived. The hospital capacity is insufficient. Many wounded are still lying in the streets. This is hard and frustrating but reality. We do the best we can but the possibilities are less than optimal.
Ray Vanholder
Chairman ISN Renal Disaster Relief Task Force
First report of the ISN-RDRTF, January 14, 2010
Second report of the ISN-RDRTF, January 18, 2010
More information on the ISN-RDRTF
Coordination Center
Raymond Vanholder, Chairman ISN Renal Disaster Relief Task Force
Assistant: Chantal Bergen
E-mail 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
