Thursday, January 28, 2010

Haiti: Obama's Katrina. Many post-quake deaths could have been prevented."The Wall Street Journal"


Es obvio, al leer en este articulo que la capacidad logistica de Naciones Unidas y Estados Unidos esta muy por debajo de escenarios como el Katryna y el reciente terremoto de Haiti, independientemente del Presidente que gobierne, por todo lo cual debemos sacar sacar conclusiones para prevenir respuestas ante  la posibilidad de proximos escenarios similares en el area America.Gualterio Nunez Estrada, Sarasota, Florida, 34232.


"The U.S. response to the earthquake should be considered an embarrassment. Our operation received virtually no support from any branch of the U.S. government, including the State Department."
“měi guó yìng duì dì zhèn yīng gāi bèi rèn wéi shì gān gà。wǒ men de xíng dòng jī hū méi yǒu dé dào rèn hé bù mén de zhī chí shì měi guó zhèng fǔ, bāo kuò guó wù yuàn。”
"Những phản ứng Mỹ cho trận động đất nên được coi là một bối rối hoạt động của chúng tôi đã nhận được hầu như không có sự hỗ trợ từ bất kỳ chi nhánh của chính phủ Hoa Kỳ, trong đó có Bộ Ngoại giao.."
"La risposta degli Stati Uniti per il terremoto dovrebbe essere considerato un imbarazzo. La nostra operazione ha ricevuto praticamente nessun sostegno da tutte le filiali del governo degli Stati Uniti, tra cui il Dipartimento di Stato."
La réponse américaine au tremblement de terre devrait être considéré comme un embarras. Nos opérations ont reçu pratiquement aucun soutien dans toutes les agences du gouvernement américain, y compris le Département d'Etat."

"Реакция США на землетрясение должно рассматриваться смущения. Наша деятельность получила практически никакой поддержки от любой ветви власти США, в том числе Государственного департамента".

By SOUMITRA R. EACHEMPATI, DEAN LORICH AND DAVID HELFET

Soumitra R. Eachempati, MD, FACS



Associate Professor of Surgery


Associate Professor of Public Health


Weill Cornell Medical College


Associate Attending Surgeon


NewYork-Presbyterian Hospital/Weill Cornell Medical Center


Phone: (212) 746-5312


Fax: (212) 746-0982


E-mail: sre2003@med.cornell.edu


Specialties: Trauma surgery, colon surgery, gallbladder surgery, gallstones, gastrointestinal surgery, general surgery, hernia surgery, laparoscopic gastrointestinal surgery, laparoscopic surgery, and pancreatic disease


Physician Profile: More about Soumitra R. Eachempati, MD

Four years ago the initial medical response to Hurricane Katrina was ill equipped, understaffed, poorly coordinated and delayed. Criticism of the paltry federal efforts was immediate and fierce.
Unfortunately, the response to the latest international disaster in Haiti has been no better, compounding the catastrophe.
On Tuesday, Jan. 12, a major earthquake overwhelmed a country one hour south of Miami whose inhabitants include American citizens and their relatives. Thanks to the Internet, pictures of the death and destruction were familiar to the world within hours, and the need for a massive influx of relief and specialized medical care was instantaneously apparent. While particular fatalities such as head injuries or massive blood loss are rarely treatable in mass casualty situations, delayed deaths from infection may be preventable.
On Wednesday, the day after the quake, we organized a relief team in cooperation with the U.S. State Department and Partners in Health (a Boston-based humanitarian organization) to provide emergency orthopedic and surgical care. We wanted to reach the local hospitals in Haiti immediately—but were only allowed by the U.S. military controlling the local airport to land in Port-au-Prince Saturday night. We were among the first groups there.

This delay proved tragic. Upon our arrival at the Haiti Community Hospital we found scores of patients with pus dripping out of open fractures and crush injuries. Some wounds were already infested with maggots. Approximately one-third of the victims were children. Most of the patients already had life-threatening infections, and all were dehydrated. Many had been waiting in the hospital compound for days without water, antibiotics or even pain medicine. The hospital smelled of infected, rotting limbs.
Our team spent the next 60 plus hours performing a variety of operations including orthopedic repairs to broken limbs and amputations. Sadly, a limb amputation in an underdeveloped country may be a death sentence.
 
We tallied over 100 operations between four surgeons and three orthopedic fellows (medical doctors getting additional specialty training), and evaluated perhaps 100 more patients for surgery. In contrast, a busy night in a New York City hospital might include four or five surgeries. Hindering the effort was an absence of ventilators, anesthetic machines, and oxygen tanks. There was no blood bank or laboratory, and a dearth of surgical instruments. Due to the lack of resources, we know many patients may still succumb to infection and other postoperative complications.
The U.S. response to the earthquake should be considered an embarrassment. Our operation received virtually no support from any branch of the U.S. government, including the State Department. As we ran out of various supplies we had no means to acquire more. There was no way to transfer patients we were poorly equipped to manage (such as a critically ill newborn with respiratory distress) to a facility where they would get better care. We were heartbroken having to tell patients suffering incredible pain we could not perform their surgery for at least a day.
Even after hearing gunshots outside the hospital, we had no protection for ourselves or our belongings—though we observed that a Jamaican medical team came with armed guards.
All these problems stemmed from ours being an isolated operation, a feature that may work in a humanitarian medical mission but not in a disaster situation. Later, as we were leaving Haiti, we were appalled to see warehouse-size quantities of unused medicines, food and other supplies at the airport, surrounded by hundreds of U.S. and international soldiers standing around aimlessly.
With an organized central command dedicated to medical relief, we could have done much better. A reconnaissance team, managed by government or U.N. officials in conjunction with medical and logistic specialists, could have immediately come to Haiti to evaluate local facilities. Preapproved groups of experienced civilian and military medical teams could have been consolidated in the U.S. from the Pensacola, Fla., military base or other locations, to avoid the airplane traffic clutter and delays that plagued landing of people and supplies into Port-au-Prince. Targeted teams with military support could then go to adequate facilities where they could be most effective.
After the disaster, certain roads should have been secured to allow the transfer of patients or supplies. A base hospital could have been established for patients requiring specialized services (such as a neonatal ICU and neurosurgery). A specialized, postoperative care center should have been established. In our case, however, we lacked the resources to ensure that patients were receiving basic wound care, antibiotics, nutrition or hydration.
The death toll from Katrina was under 2,000 people. Deaths in Haiti as of yesterday are at least 150,000. Untold numbers are dying of untreated, preventable infections. For all the outcry about Katrina, our nation has fared no better in this latest disaster.




Dr. Eachempati is a trauma surgeon and incoming president of the New York State Chapter of the American College of Surgeons. Drs. Lorich and Helfet are orthopedic surgeons. All practice at the Weill Cornell Medical Center in New York City.



Dr. Eachempati is involved in a busy clinical surgical practice, multiple research interests, and extensive teaching responsibilities to the medical students at the Weill Medical College. His research interests include topics pertinent to abdominal surgery, critical care, and trauma. He is board-certified by the American Board of Surgery in both General Surgery and Surgical Critical Care.





Dr. Eachempati attended college at Georgetown University in Washington, DC, where he received a Bachelor's of Science in chemistry in 1987. He then went to Northwestern University in Chicago, Illinois where he graduated in 1991 with an MD. He completed his general surgery internship and residency in 1996 from Wayne State University in Detroit, Michigan. As a resident, Dr. Eachempati received multiple awards for teaching excellence. During this time, he was also selected to participate in an educational project in Hanoi, Vietnam where his group taught Vietnamese surgeons new techniques in laparoscopic surgery.
After residency, Dr. Eachempati worked at Duke University Hospital where he completed a fellowship in Surgical Critical Care in 1997. During this time, he published multiple studies in critical care and trauma surgery. Following this fellowship, he received an academic appointment as an Instructor of Surgery in the Department of Surgery at Duke University School of Medicine in 1997. Following one year as an attending surgeon at Duke, he moved to New York City to become an Assistant Professor of Surgery at the Weill Medical College of Cornell University.
Gender-based differences in outcome in patients with sepsis


SR Eachempati, L Hydo, PS Barie - Archives of Surgery, 1999 - Am Med Assoc

Hypothesis Among factors postulated to affect outcome in sepsis is the gender of the patient,

with a suggestion that females may have lower mortality. This study tested the hypothesis that

female patients admitted to the surgical intensive care unit with a documented infection ...

Cited by 131 - Related articles - BL Direct - All 4 versions



Acute acalculous cholecystitis

PS Barie, SR Eachempati - Current Gastroenterology Reports, 2003 - Springer

Patterns of Clinical Illness Reports of acute cholecystitis complicating surgery, multiple

trauma, or burn injury are widespread. In patients with gall- stones, the incidence of postoperative

cholecystitis is similar for males and females. However, more than 80% of patients ...

Cited by 132 - Related articles - BL Direct - All 6 versions



Interpretation of computed tomography does not correlate with laboratory or …

MJ Weyant, SR Eachempati, MA Maluccio, DE … - Surgery, 2000 - Elsevier

... confirmed acute appendicitis. Michael J. Weyant MD, Soumitra R. Eachempati MD,

Mary A. Maluccio MD, David E. Rivadeneira MD, Stephen R. Grobmyer MD, Lynn

J. Hydo BSN and Philip S. Barie MD. From the Department ...

Cited by 64 - Related articles - BL Direct - All 3 versions



Factors influencing the development of decubitus ulcers in critically ill surgical …ig.com.br [PDF]

SR Eachempati, LJ Hydo, PS Barie - Critical care medicine, 2001 - journals.lww.com

Skip Navigation Links Home > September 2001 - Volume 29 - Issue 9 > Factors influencing the

development of decubitus ulcers in c... ... From the Department of Surgery, Weill Medical College

of Cornell University, Anne and Max A. Cohen Surgical ICU, New York-Presbyterian ...

Cited by 56 - Related articles - BL Direct - All 6 versions

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