Spinal cord injury in postearthquake Haiti: lessons learned and future needs.

D C ust before 5 PM on January 12, 2010, a 7.0 earthquake struck Haiti, a Caribbean nation that hares the island of Hispaniola with the Dominican Republic. The epicenter was approxiately 10 miles southwest of Port-au-Prince, the capital of Haiti. Port-au-Prince is the ountry’s largest city and is an overcrowded, sprawling urban center with a population efore the earthquake of approximately 3 million people, including the surrounding areas. he earthquake was devastating and more than twice as lethal as any previous magnitude .0 event [1]. Precise totals will never be known, but current United Nations estimates are 50,000-300,000 deaths, which is more than twice that of the atomic bomb dropped on iroshima at the end of World War II [2]. In addition, there were 300,000 injuries and 45,000 buildings were destroyed (Figure 1), which rendered 1.5 million Haitians homeess, most of whom are now living in tent cities [1-3]. Before the earthquake, Haiti was the poorest nation in the Western Hemisphere and was anked 149 on the 2009 Human Development Index [4]. The existing health care system as tenuous, and the majority of Haitians did not have access to regular health services. lthough the response from the international community was swift and massive, first esponders were still placed in the unenviable position of having to ration medical care ecause the sheer magnitude of the tragedy outstripped available resources. Some facilities ecided not to treat catastrophic injuries, such as spinal cord injuries (SCI), because of the esource intensive needs of these patients, perceived low survival rates, and “minimal hance of ultimate rehabilitation . . .” [5]. Nevertheless, despite the challenging circumtances, initial efforts led to the stabilization and survival of many individuals with injuries hat would have likely been life-threatening in pre-earthquake Haiti. Before the earthquake, individuals living with severe SCIs were largely nonexistent in aiti. Although the exact number and survival rate before the earthquake is unknown, the eeling among rehabilitation professionals with long-standing involvement in Haiti is that ndividual cases were sporadic and that persons with severe injuries, if they survived the nitial injury and acute period, typically died within the first 1-2 years. This would be onsistent with other developing nations. Under these circumstances, there was little need or expertise in the delivery of care to individuals with SCIs. Likewise, there were no true npatient rehabilitation beds for individuals with SCI. The events of January 12 led to an unprecedented number of SCIs. A preliminary report y Handicap International estimated that there were more than 100 survivors with SCIs [6]. he number is now thought to be closer to 150 despite the fact that most persons with ervical injuries did not survive. The situation was compounded by damage to medical acilities, for example, the General Hospital in Port-au-Prince. An undetermined number of ersons with SCIs were transferred to facilities outside Haiti, including the United States. iven that acute care facilities were stretched beyond their capacity, an urgent need arose for atients to be discharged to alternative settings once stabilized. Under these difficult and ire circumstances, 3 organizations established SCI units to address this pressing need: Haiti ospital Appeal (HHA) in Cap-Haitien (northern Haiti), Project Medishare/Univeristy of iami in Port-au-Prince (central Haiti), and St. Boniface Hospital in Fond-des-Blancs southern Haiti). Currently these facilities are caring for approximately 60 individuals with CI. Two authors (A.S.B., M.D.L.) were recently part of an interdisciplinary team from the oronto Rehabilitation Institute (TRI) that, in partnership with Team Canada Healing S c