The earthquake did not kill Youseline Paupilaire, but gangrene nearly did. She was brought to Haiti’s only functioning children’s hospital early yesterday with a festering double fracture to her lower left leg, and anaesthetised at 10.40am.
The first smell of amputation was that of burning flesh, as an Italian surgeon cauterised the blood vessels that he had severed with a neat incision around the leg. Then he pulled back the muscle and asked a colleague to hold it steady. At 11am he cut off Youseline’s foot with a hacksaw blade.
Youseline is 11, without parents or any known relatives. She is permanently disabled in a country that can barely look after the fully fit, yet she is alive. Stefano Calderali has lost count of how many amputations he has performed since landing in Port-au- Prince last Wednesday. “Thirty-five, maybe forty,” he said. “My own saw broke after the first ten.”
Gangrene can set in within 24 hours of an injury, and after six days is almost always fatal without emergency surgery. A full week since the earthquake, doctors at St Damien’s children’s hospital and field hospitals across the city are bracing themselves for a new wave of death, and amputating continuously to limit its impact.
“I am in God’s hands,” said Michaela Pierre-Louis, 9. She was waiting for her left arm and chest to be X-rayed before taking her place in the queue for surgery yesterday. “I am glad my mother brought me.”
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Outside the hospital under an awning set up next to two extra mobile operating theatres, patients were given numbers to keep their place in the queue. Marie-Marlene Sidone was No 14. “They say my leg is not broken, only the veins,” she said. “Until yesterday we did not think it was too bad. Then I couldn’t feel my toes any more.”
She will almost certainly lose her leg, and thereby live. This brutal calculus is saving hundreds of people who in most cases arrive with no idea how dangerous their infections have become, or what lies in store for them.
“These patients are all septic and some are in septic shock, so it’s a rush to cut before the gangrene flows in,” said Thomaso Pellis, an anaesthetist running two wards for 20 hours a day at St Damien’s.
“The children know nothing,” Dr Calderali said. “The problem is the reaction of relatives.” His point was made moments later outside the theatre, where Merlynne Claude was waiting for her younger sister to emerge from surgery for an infected finger. Told it could mean amputating the arm, she staggered backwards and had to be supported by her brother.
“For parents it’s often hardest,” said Father Peter Arteaga, of the Foundation of Our Little Brothers and Sisters, which runs the hospital. “Some parents just leave their children here. Yesterday I saw a mother who could not bring herself to touch her two year-old son when he got out of surgery.” The boy had lost his leg.
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Spacious, clean and earthquake-proof, St Damien’s is an object lesson in the type of infrastructure that Haiti needs but desperately lacks. It was the only hospital of any kind in Port-au-Prince to survive the earthquake intact and keep its doors open throughout. A massive medical emergency is otherwise being handled entirely by field hospitals flown in from as far away as Israel.
The inflow of new patients is continuous, and no one is turned away. Yesterday a 101-year-old woman, emaciated beyond measure, was brought in on a stretcher and left by good Samaritans who knew nothing about her but her age. Next to her lay Herby ?mile, 21, alive after three days in the rubble but terrified of an infection that he can feel “swelling as if it will explode”. He managed a smile. “It’s tearing at my leg. I can’t wait long.” I asked if he knew that they would have to amputate. “I must resign myself to it,” he said. “If they don’t cut, I know I will die.”
The hospital cannot save everyone. Once infection takes hold no amount of antibiotics or surgery can help. “That’s when they call me,” Father Peter said. “We have a room here we use as a hospice. We don’t tell them they are going to die, just that we have done all we can and we must wait and see.” He hasn’t counted the number of times he has read the last rites since the earthquake. “Hundreds,” he said. “I don’t know.”
In the operating theatre a junior doctor watching Dr Calderali work said something to himself about prosthetics, and sighed with exhaustion. “She will need so much when we discharge her. Nursing. Rehabilitation. It’s expensive anywhere, and here? We can only hope.”