“Welcome to Haiti,” I said with a smile and hugged the resident as she arrived at the hospital. Shortly after, we loaded up into a white SUV and headed out for the Central Plateau. I asked the driver to take Route 9, the long road that winds around the city, to avoid the constant, grating traffic of Carrefour. He obliged with a smile.
Twenty minutes outside of Port-au-Prince, the SUV cruised along Route 9, dodging potholes the size of small craters, carefully choosing the easiest spots to move over the uneven asphalt. Two cars in front of us suddenly slowed to a stop, and screams rose above a baseline of frantic shouting. On the right side of the road, a mass of people swarmed around a yellow school bus that was perched precariously over a drainage ditch, perpendicular to the road, its rear emergency door open onto Route 9. Our driver slowed to a crawl and pulled into the left lane to pass around the mess and continue to the Plateau.
We gawked at the mass of people, unsure what to make of the chaos. Traffic had not had time to build up behind the accident, meaning that the bus had just veered off of the highway. In Haiti, passengers regularly stand up in buses or sit on the roof when there are no seats available — a mere pothole has the potential to spell their doom.
Three men emerged from the crowd, holding another man up by his arms and one leg, placing him on the ground near the road. His jeans were bloody right below his left knee, and a large gash across his forehead was pumping blood into the dirt around him.
“Kanpe. Map desamn.” The driver looked at me, and I repeated to him to stop the car and let me out. The resident and I stood next to the man squirming on the ground, watching the blood spurt out of his forehead in time with his rapid heart rate. I grabbed a piece of soft cardboard litter off the ground and pressed it against the wound on the forehead while she ran back to the car to grab one of her towels. He continued to flail around when a woman screamed behind me, arising from underneath the bus. The bus was perched on both sides of a drainage ditch, and passengers or pedestrians could have been trapped underneath the behemoth. People peered under and around the front end of the bus, calling out to somebody.
As I was going to investigate the poor soul trapped under the bus, I remembered that I was responsible for the resident, whose pants were covered in blood. I turned to her, “Do not move from this spot. Ok?” She nodded and smiled, grabbing at the man’s flailing arms and pressing her towel to his forehead wound. I jogged off, frantically searching under the bus for the trapped patient. I searched in the bus and under all four wheels and the front end before realizing that we were calling out to an injured soul who didn’t exist.
An ambulance roared to the scene and I grabbed a limb of the man with the head wound to load him in the back. The left leg gave completely, bending both above and below the knee and twisting in a spiral. I supported the damaged limb to relieve the pressure and hoped the other two men could lift him from the upper body. With his jeans obstructing my view, I couldn’t even determine which way to spin the leg to line it up properly — it turned in a complete circle, the foot pointing forward just as easily if I spun it clockwise or counterclockwise.
I stepped up into the back of the Land Cruiser ambulance supporting the mangled leg as the other men slid the patient along the floor. While stepping deeper into the ambulance to drag the patient further in, another set of Samaritans placed an obese, naked woman at the entrance to the ambulance. As they pushed her bare bottom along the floor, my patient’s leg slid up next to him sideways. I frantically attempted to stabilize his leg by tightly wrapping the resident’s towel around it. Then another patient, a large man with broad shoulders and a yellow polo shirt, was loaded into the back.
I was deep inside the ambulance, my egress blocked by injured patients. A schoolgirl with a plaid jumper and a large head laceration jumped into the front seat next to the driver, and the vehicle started moving away. I had intended to load the patients and then send the ambulance to Project Medishare’s trauma hospital, calling ahead to alert the staff of the mass casualty event. “Kanpe. Kanpe. I need to get out,” I said to the driver and he slowed momentarily before accelerating again as I stooped to rearrange the twisted leg. With that, we were speeding back towards the hospital, away from the resident and the car I had come in. I stuck my head out the window to shout to our driver to meet the ambulance at the hospital, but when I felt the wind off of a truck’s side-view mirror rush past my head, I quickly ducked back inside.
Hoping that someone had seen me board the ambulance, I turned my attention to the patients. The naked woman was in her sixties, and had a thin cloth now draped over her groin. She wailed to me in unintelligible Creole. She must have been a pedestrian, standing outside of her house when the massive bus plowed through her neighborhood. I have no idea how or when she lost her clothing, but she was too hysterical to communicate where her pain was and I couldn’t palpate any noticeable bumps or fractured bones.
I called ahead to the hospital as the ambulance screamed down the road. Two men were hanging out the back of the ambulance, the doors unable to close with so many passengers. One pothole or aggressive motorcycle driver and we’d have two more casualties fall out the back. The man with the twisted leg under me was slowly coming to, answering my questions, telling me his name and complaining of severe pain in the leg.
The ambulance finally roared into the hospital and the EMTs immediately unloaded the closest passenger, the broad-shouldered man.
“No. Put him down. This guy first and then the woman and then your guy.” I instructed them on the urgency of each patient. Triage is a necessity when there are only two stretchers and two emergency room beds. They handed me gloves to cover my bloody hands, and we slowly lowered the man with the twisted leg onto a stretcher and wheeled him into the emergency room.
Fortunately for the injured, a team of Canadian orthopedics specialists were working in the hospital that week. They quickly cut off the pants of the man with the twisted leg and placed him back in an anatomically-correct position. The broad-shouldered man also had an open fracture (bone protruding through the skin), concealed by his stoicism on the ambulance ride. The naked woman, despite her wailing, was the least injured with only a broken collarbone. She sat outside the emergency room in a wheelchair and was draped in a sheet.
After washing the blood off of my hands, I remembered the resident. At that moment, she walked into the emergency room wearing a huge grin. Other than the blood on her pants, she was in the same condition as when she had deplaned an hour earlier. We hopped back into the SUV and headed down Route 9, this time sitting in traffic because of the accident, before finally passing the scene and speeding off into the mountains.
Vincent DeGennaro is an internal medicine doctor and a global public health specialist at the University of Florida’s Division of Infectious Diseases and Global Medicine and works half time in Haiti with the nonprofit Project Medishare. See his An American Doctor in Haiti blogs.