Fieldset
Haiti: An assignment like no other

A fuel truck explodes. Dozens are injured or killed. MSF surgeon Karry Jose Felix explains how a dedicated medical team assembled to save lives in a country where a weak healthcare system and political and economic instability made the consequences of the explosion even more urgent...

"We are doing our best to put together an international team, but we still can't find a burn surgeon available to go to Haiti."

The MSF manager in Paris explained the situation rapidly. The team was needed to respond to a major explosion in Cap-Haitien, a port city on the north coast of Haiti. On the night of 13 December 2021, a fuel truck had exploded, killing or injuring dozens of people.

Complex care

Burn victims are complex patients, with very high mortality and serious after-effects if not treated properly.

The manager explained that MSF had sent a medical team to the scene soon after the incident. They had organised the transfer of some of the severely wounded to the specialised burns hospital it runs in Port-au-Prince, Haiti's capital. But for the others, care had to be provided on site.

No easy task

It was the holiday season, and finding surgeons available to join an emergency assignment in a "red" (in terms of security) country was not an easy task.

I immediately volunteered. I'm Haitian myself, and a surgeon specialised in burns. But more than that: Cap-Haitien is my home town, so I am familiar with the place, the health facilities and the surgeons.

On 24 December I was on a plane, along with other MSF specialists who had been rapidly assembled to continue the medical activities for survivors of the blast.

Challenges

Quickly, we got started. Together with the team on site, we worked to stabilise critical patients and to move into what's known as the "reconstruction" phase of burns treatment: excisions and skin grafts. We organised the workflow, placed the necessary orders for tests and medications, and recruited and trained some additional staff.

The patients' courage was a source of motivation for our team...

We faced many difficulties. The hygiene conditions were precarious. There was a lack of equipment, paraclinical examinations and blood tests. The hard-working local staff did not have extensive experience in the treatment of severe burns.

Working together

However, everyone's dedication, with different strengths working in synergy, allowed us to provide the medical care the patients needed, while gradually increasing the skills and confidence of the local staff.

We shared our knowledge about the resuscitation of burn victims and how to identify signs of sepsis. We focussed on skills like performing skin grafts, and showed the impact of introducing physiotherapy early on to prevent functional and cosmetic problems. All of this thanks to the collaborative approach of the whole team.

Bravery and strength

The resilience of the patients and the trust they placed in us also impressed me. Most, if not all, of them had lost loved ones in the fire, and their courage was a source of motivation for our team.

After five weeks, the intensive care management of the cohort of blast victims (as well as some new admissions) was almost complete.

Although we were not able to save all of our patients, we were proud that the vast majority of them had come through and were starting their outpatient follow-up treatment.

A dual role

Looking back, it's a bit of a strange feeling to be an expatriate in your own country, having to follow strict safety rules in a familiar environment, or not being able to spend time with your loved ones.

However, I am proud to have joined the Cap-Haitien team. This dual role allowed me to act as a facilitator between the different people involved.

Many challenges remain in Haiti. However, I left Cap-Haitien with the feeling that I had been there for my people at a time when they really needed it.

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Top image shows a psychologist talking with one of the blast survivors at the MSF Trauma and Burns Hospital, Tabarre, Port-au-Prince

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