PM&R efforts in Haiti

[AviatorDoc]

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Does anyone have an idea what role physiatry is currently playing in the relief efforts? I can't even imagine the number of new amputees, spinal cord injuries, and brain injuries to the population. At the risk of sounding too self-interested, I believe placing rehabilitation at the forefront of relief efforts would help the international view of physiatry as well. Undestandably, the surgical and medical specialties are most needed right now, but in the coming weeks and months, I would think there would be plenty of opportunity for PM&R.

Thoughts?

 

[rehabdocmd]

AAPMR sent an email out today, that they are working with major organizations to line up volunteer opportunities but no specifics

Does anyone have an idea what role physiatry is currently playing in the relief efforts? I can't even imagine the number of new amputees, spinal cord injuries, and brain injuries to the population. At the risk of sounding too self-interested, I believe placing rehabilitation at the forefront of relief efforts would help the international view of physiatry as well. Undestandably, the surgical and medical specialties are most needed right now, but in the coming weeks and months, I would think there would be plenty of opportunity for PM&R.

Thoughts?

 

[PMR 4 MSK]

Does anyone have an idea what role physiatry is currently playing in the relief efforts? I can't even imagine the number of new amputees, spinal cord injuries, and brain injuries to the population. At the risk of sounding too self-interested, I believe placing rehabilitation at the forefront of relief efforts would help the international view of physiatry as well. Undestandably, the surgical and medical specialties are most needed right now, but in the coming weeks and months, I would think there would be plenty of opportunity for PM&R.

Thoughts?

Once the acute issue is over and people tire of seeing collapsed buildings and piles of bodies, the general population will lose interest - they always do. Tragedy brings ratings to the TV and radio stations and everyone throws a bunch of money at the issue. Once the cameras walk away, the money quickly dries up. There is unlikely to be significant money available for rehab services.

Haiti has no real Goverment now, will be completely bankrupted by this and will have a hard time recovering. Volunteers will be greatly needed, but overwhelmed.

You are right, they will need extensive rehabilitation services, but where will it come from? Braces, wheelchairs and prosthetics will be very difficult to come by. PT will be virtually non-existent. The best you will be able to do is provide advice to caregivers. Just like all the people right now who need surgery and antibiotics, but can't get them.

 

[MSKalltheway]

Just had a piece about this on Larry King Live with Heather Mills talking about her volunteer efforts.

Mentioned something about physiciansforpeace.org for info on efforts as well.

 

[AviatorDoc]

Now is the time to get in with the charitable organizations to lobby for basic DME, set aside funds for PT, etc. If it isn't carved out of the monies being showered upon Haiti now, then it won't happen.

I may have an optimistc view, but I believe PM&R can play a role, even when there is little funding: Teaching the concept of functional outcomes, teaching strategies for living w/ SCI, dispensing rudimentary prostheses w/ basic gait training, etc. Even more so than our pampered world, the folks who have little can gain the most from simple strategies. Just as surgeons have learned to do their job w/ very restricted resources, couldn't physiatrists as well?

 

[axm397]

http://www.healinghandsforhaiti.org...nstitute/tabid/71/language/en-US/Default.aspx

My friend went to Haiti last year for them.

 

[ReadyFreddy]

An estimated 200,000 amputations ... it's a number that's hard to fathom for me.

http://news.bbc.co.uk/2/hi/health/8475806.stm

 

[Hemisphere]

Now is the time to get in with the charitable organizations to lobby for basic DME, set aside funds for PT, etc. If it isn't carved out of the monies being showered upon Haiti now, then it won't happen.

I may have an optimistc view, but I believe PM&R can play a role, even when there is little funding: Teaching the concept of functional outcomes, teaching strategies for living w/ SCI, dispensing rudimentary prostheses w/ basic gait training, etc. Even more so than our pampered world, the folks who have little can gain the most from simple strategies. Just as surgeons have learned to do their job w/ very restricted resources, couldn't physiatrists as well?

Hear, Hear! Something is better than nothing 2 times out of 3, or so I've heard. The relief efforts right now I believe are still in the acute phase both medical and as far as rebuilding infrastructure and engineering. Once the situation is more stable for aide workers who don't need to be "disaster environment self-sufficient" and they have restored some food, water, electric supply, I would hope physiatrists could help during the rehabilitation phase. In the meantime, I did support the Clinton-Bush Haiti fund to help during the acute phase.

 

[MSKmonky]

There can definitely be efforts by PMR physicians. Way back in the day, during the Earthquake relief efforts for Northern India (2000?) I (college student at the time) went to one of the relief camps and worked with a group of physiatrists along side prosthetists to provide care to new amputees. Awesome exerience. They also did a good deal of Musculoskeletal assessments/joint care. This was a year after the earthquake had hit however so these "rehab centers" were made after the media-buzz had long since dwindled.

 

[MSKmonky]

There can definitely be efforts by PMR physicians. Way back in the day, during the Earthquake relief efforts for Northern India (2000?) I (college student at the time) went to one of the relief camps and worked with a group of physiatrists along side prosthetists to provide care to new amputees. Awesome exerience. They also did a good deal of Musculoskeletal assessments/joint care. This was a year after the earthquake had hit however so these "rehab centers" were made after the media-buzz had long since dwindled.

 

[badbrains]

http://www.nytimes.com/2010/01/25/world/americas/25amputee.html

"Nearly two weeks after the 7.0-magnitude earthquake that devastated Port-au-Prince, the immediate health crisis, which involved treating the injuries of people who were crushed by collapsing buildings and amputating damaged limbs, has begun to settle into a new phase.
This one is perhaps even more daunting: caring for thousands of post-operation trauma patients who are ready to leave the hospitals, but lack homes or families to go to. Many will require prosthetic limbs, frequent wound cleanings, bandage changes and months of rehabilitation.

Early reports that there might be as many as 200,000 people who required amputations appear to have been exaggerated. At the University Hospital, Port-au-Prince’s largest hospital, which received the brunt of the casualties after the quake, surgeons have performed about 225 amputations, mostly in the first few days. Doctors Without Borders estimated that its doctors had performed 125 amputations in 12 centers across the country. Hundreds more have been done in other clinics and hospitals elsewhere; the total is more likely to have been a few thousand.

Even in the best of circumstances, it can take four to six months for a person who has had a traumatic amputation to function again, Dr. Steven R. Flanagan, medical director of the Rusk Institute of Rehabilitation Medicine at N.Y.U. Langone Medical Center, said in a telephone interview. The Rusk Institute has a team in Haiti.
“What they really need to worry about in Haiti is infectious complication, so if you have an amputation of a leg or arm, that wound is subject to infection,” Dr. Flanagan said. “And clearly they don’t have all the medicines they need down there.”

 

[PMR 4 MSK]

One of my partners just got back from there with a few other orthopods. They did about 50 surgeries in 3 days - mostly femur and pelvic fractures. They brought many thousands of dollars worth of supplies from our clinic, and got Stryker to donate hundreds of thousands of dollars worth of supplies, including ORIF and ex-fix plates, screws, etc, a C-arm, and much more. They plan to go back in a few weeks to do more. They were at a public hospital in the Domincan Republic that has taken many of the Haiti victims.

He showed pictures today - beds with thin mattresses and no sheets. Holes in the walls leading to outside. Only 1 autoclave that barely worked. People boiling gauze to use and wrapping it in paper bags (what we would call grocery bags... yeah, same paper). The hallways were packed with patients with no where to put them. There were so many they could not help due to time and lack of supplies.

Most of the femur fracture patients had a single traction pin placed and had been on their backs for weeks. He said the smell of festering wounds, including decubiti was astounding. The flies were everywhere. Patients had no charts and the team didn't know most of their names.

They did IM rods and nails with spinals that were often partial blocks, no sedation. He said these people were incredible stoics. They even invented a few techniques to use for lack of equipment, and plan to publish these soon.

The state of orthopedic medicine there was abysmal by our standards - long leg cast + pelvic spica for weeks for a pt with pelvic fx - essentially a death sentence from sepsis from decubiti or PEs. No anticoagulation, no decubiti prevention. Minimal if any, antibiotics or pain killers.

As I said before, the need for rehabilitative services there is huge, but there is no one to provide it or fund it.

And we get patients here who want Norco 10's Q4H because they have fibromyalgia or degenerative disk disease. Or they whine when they have to wait a couple extra days for Public aid to approve their Lyrica.

Here's a link to their blog

http://www.haitianhelp.typepad.com/

 

[axm397]

Here's our blog: http://txortho.blogspot.com/

We actually are at one of the six functioning hospitals in Haiti. Every week, there is a team of docs/nurses/techs who go - combo of anesthesia/pain, ortho, wound care, ER, etc.

They are anticipating PM&R/prosthetics/wound care needs in the near future.

 

[rehabdocmd]

Interesting article. So have the NYU residents had a chance to participate in this RUSK team? Thats great that NYU RUSK has a team in Haiti.

http://www.nytimes.com/2010/01/25/world/americas/25amputee.html

"Nearly two weeks after the 7.0-magnitude earthquake that devastated Port-au-Prince, the immediate health crisis, which involved treating the injuries of people who were crushed by collapsing buildings and amputating damaged limbs, has begun to settle into a new phase.
This one is perhaps even more daunting: caring for thousands of post-operation trauma patients who are ready to leave the hospitals, but lack homes or families to go to. Many will require prosthetic limbs, frequent wound cleanings, bandage changes and months of rehabilitation.

Early reports that there might be as many as 200,000 people who required amputations appear to have been exaggerated. At the University Hospital, Port-au-Prince’s largest hospital, which received the brunt of the casualties after the quake, surgeons have performed about 225 amputations, mostly in the first few days. Doctors Without Borders estimated that its doctors had performed 125 amputations in 12 centers across the country. Hundreds more have been done in other clinics and hospitals elsewhere; the total is more likely to have been a few thousand.

Even in the best of circumstances, it can take four to six months for a person who has had a traumatic amputation to function again, Dr. Steven R. Flanagan, medical director of the Rusk Institute of Rehabilitation Medicine at N.Y.U. Langone Medical Center, said in a telephone interview. The Rusk Institute has a team in Haiti.
“What they really need to worry about in Haiti is infectious complication, so if you have an amputation of a leg or arm, that wound is subject to infection,” Dr. Flanagan said. “And clearly they don’t have all the medicines they need down there.”

 

[axm397]

AAPMR sent an email out today, that they are working with major organizations to line up volunteer opportunities but no specifics

Specifics - if you participated in the survey they sent out, this is what you would have gotten:

Thank you for responding to the Academy's recent survey about PM&R care of Haiti survivors.

With thanks to Academy member Diane Cardenas, MD, MHA, AAPM&R has identified a relief organization—Project Medishare (www.projectmedishare.org), in partnership with the University of Miami—that is operational in Port-au-Prince, Haiti, and specifically looking for volunteers at this time from the PM&R specialty.

Our Haiti Relief web page—www.aapmr.org/member/haiti_earthquake.htm—devoted to identifying resources and organizations that support the victims of the Haiti earthquake has been updated with volunteer information and links to Project Medishare to register.

As your Academy identifies other organizations that are specifically requesting volunteers from PM&R and have the appropriate relief infrastructures in place, we will make that information available on this page of our Web site. Your Academy is also actively advocating for the inclusion of PM&R and rehabilitation services with a number of agencies and NGOs active in the relief effort. There is also a link on our Haiti Relief web page to register on a physician volunteer database being maintained by the American Medical Association that will be utilized by other NGOs seeking PM&R volunteers.

Thank you again for your interests in volunteering and bringing critical rehabilitation medical services to the Haitian people devastated by the earthquake.

 

[joseppi]

When the AAPMR message first came out I had looked into it, the way the registration read it apppeared they wanted only practicing physicians. Do you know if residents go? Also how are people getting down there?
For time period available I beleive it was something like 2weeks, 1month, or 2 months+. Not sure if this still holds true. I know my residency would not provide malpractice coverage outside its institution - is this a non-issue given the situation? Thanks-

Specifics - if you participated in the survey they sent out, this is what you would have gotten:

Thank you for responding to the Academy's recent survey about PM&R care of Haiti survivors.

With thanks to Academy member Diane Cardenas, MD, MHA, AAPM&R has identified a relief organization—Project Medishare (www.projectmedishare.org), in partnership with the University of Miami—that is operational in Port-au-Prince, Haiti, and specifically looking for volunteers at this time from the PM&R specialty.

Our Haiti Relief web page—www.aapmr.org/member/haiti_earthquake.htm—devoted to identifying resources and organizations that support the victims of the Haiti earthquake has been updated with volunteer information and links to Project Medishare to register.

As your Academy identifies other organizations that are specifically requesting volunteers from PM&R and have the appropriate relief infrastructures in place, we will make that information available on this page of our Web site. Your Academy is also actively advocating for the inclusion of PM&R and rehabilitation services with a number of agencies and NGOs active in the relief effort. There is also a link on our Haiti Relief web page to register on a physician volunteer database being maintained by the American Medical Association that will be utilized by other NGOs seeking PM&R volunteers.

Thank you again for your interests in volunteering and bringing critical rehabilitation medical services to the Haitian people devastated by the earthquake.

 

[axm397]

Most volunteer opportunities will likely require you pay for your own travel unless they have a lot of funding/donations. A lot of the organizations are looking for specific skills - fluent in Creole/French, previous disaster relief or mission experience, etc.

I don't think malpractice insurance is an issue but getting the time off is probably more of an issue since as a resident you are required to complete certain rotations during your residency.