Hospital Replicates Haiti's Worst-Case Scenario

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Some U.S. doctors who've volunteered in post-earthquake Haiti have said they felt unprepared for the types of injuries and primitive medical settings they encountered there. Children's Hospital in Boston is running a startlingly realistic simulation program to help prepare American health care workers for the scene they'll find.

STEVE INSKEEP, host:

American health care teams are still traveling to Haiti to help with the wounded, nearly four months after the earthquake. Many medical workers have been startled by the bare-bones clinics and types of injuries they've encountered. So a new program is preparing them for what they may find.�Sacha Pfeiffer reports from member station WBUR.

Unidentified Man: Ok. Your blood pressure's going to come up on the monitor.

SACHA PFEIFFER: A half dozen doctors and nurses are packed in the chaotic operating room. A patient is bleeding from her mouth and nose. There's a deep gash in her abdomen and her right leg is mangled, the knee twisted, the foot cocked unnaturally to the side.

The room is filled with moaning. The patient cries out in Creole, saying she can't feel her leg. The doctors work as fast as they can, but they're shortstaffed and missing essential supplies.

Unidentified Man: Let's identify the surgeons also.

Unidentified Woman: Is there a surgeon here?

Unidentified Man: Is there a surgeon around?

Unidentified Woman: No surgeons.

Unidentified Man: Can we get some oxygen? Do we have oxygen?

PFEIFFER: Then things take a turn for the worse.

Unidentified Man: She's vomiting.

PFEIFFER: This may be hard to listen to, but the noises you're hearing are actually made by a nurse who's a pretty good actress. And the patient on the operating table is a mannequin. These medical workers have volunteered to go to Haiti, and this simulation is meant to get them ready.

Dr. Peter Weinstock runs this exercise for Children's Hospital in Boston. He talks with a group, later, about what went right and what went wrong.

Dr. PETER WEINSTOCK (Children's Hospital, Boston): When you turned to her, she said something that sounded like my tummy. And she was actually saying I'm falling.

Dr. TYLER HARTMAN (Pediatrician, Children's Hospital): Oh, I thought she was saying my tummy.

Dr. WEINSTOCK: Yeah, it sounded that way. And it just raises that issue again to try and use translators as best you can or realize that some of the things you're hearing my sound like certain things...

Dr. HARTMAN: Yeah.

Dr. WEINSTOCK: But may end up being very different.

PFEIFFER: Tyler Hartman was part of the simulation. He's a pediatrician at Children's and he says the unfamiliar environment was difficult.

Dr. HARTMAN: Not knowing where everything is, not knowing who the people were was extremely stressful, because I'm used to knowing who can do what and relying on those people to do those things. I just felt like I couldnt tee up for a worse, stressful situation.

PFEIFFER: But that's exactly the kind of situation many health care workers can find when they travel to Haiti, even months after the quake. Most of them don't know each other before they arrive. And basic equipment, like syringes, can be hard to come by.

So this new simulation program coaches them to make neck braces out of rolled up towels. To make oxygen masks out of plastic water bottles. To bring headlamps so they can do procedures without having to hold a flashlight. Weinstock says creativity is critical.

Dr. WEINSTOCK: We work in this environment where we would never fathom reaching for a cardboard box and putting a child in it. One of our goals was to really just open their eyes to that concept - that that may very well be the resources that are available to you.

PFEIFFER: They're also learning to recognize illnesses that have been wiped out in the U.S. One of the simulations, based on a recent case in Haiti, involves a mannequin baby suffering from what looks like epileptic seizures. The newborn actually has tetanus, caused by what doctors call dirty umbi(ph). That means its umbilical cord was cut with an unsterile instrument.

Tyler Hartman, the pediatrician, didn't make that diagnosis at first. And that made him wonder how ready he was for his Haiti trip.

Dr. HARTMAN: I'm a little bit more nervous, I think, than I was before. But, yeah, I think I'm still pretty nervous about going down there. But, yeah, I feel a little bit better about it.

PFEIFFER: Weinstock says even experienced health care workers may have a lot to learn in Haiti, so they may not hit the ground running, he says. But at least this program helps them hit the ground walking a little faster.

For NPR News, I'm Sacha Pfeiffer in Boston.

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