Order Must Follow Chaos

(Photo by John Carroll)

Published at www.nejm.org
March 3, 2010


Haiti — A View from the Ship


One of the first children I cared for after my arrival on the USNS Comfort, the U.S. Navy's floating medical treatment facility docked at Port-au-Prince, Haiti, was a 10-month-old boy who had been brought to the ship nearly dead from malnutrition. Prior to the earthquake, there had been little food, and he had been fed only a few times per week. When the earthquake hit, his mother covered him with her body. His aunt heard his cries and pulled him from underneath her dead sister. In the days following the earthquake, his kwashiorkor progressed to the point that when I met him in the ICU, his whole body was swollen and he could not move. Food works miracles, however, and over the next weeks, fed first by NG tube, then bottle, and finally spoon, he thrived, sat up, and grabbed for the food. When he was reunited with his aunt and ready for discharge, we gave instructions that he should go somewhere where he would be assured of adequate food and shelter — but that is a tall order in Haiti, as we realized.

The first phase of Haiti's earthquake disaster is nearly over. The hundreds of patients who were cared for on the Comfort and required amputations and orthopedic repair of terrible fractures have mostly left the ship. Those hundreds are but a drop in the bucket compared with the number of injured remaining on shore. The vast majority of the hospitals that used to function in Port-au-Prince were destroyed. Large segments of the population are living in the streets and in makeshift tents that will not be waterproof in the coming rainy season. Although there are many charitable and U.S. government organizations working in Port-au-Prince, the problems of sanitation, clean water, and food distribution are far from solved.

Before the earthquake, Haiti had one of the highest child mortality rates in the Western Hemisphere. Many of the patients brought to the ship were undernourished and anemic as well as injured. When the rains come, this vulnerable population will be exposed to dysentery and malaria as well as starvation.

Over the coming months, a concerted effort must be made to develop safe housing and food and water supplies as well as to ensure adequate orthopedic follow-up and access to prosthetics for the thousands of amputees. Somehow, order must emerge from the chaos of the current relief efforts. If not, the second phase of the earthquake disaster may be worse than the first, and being pulled from the rubble will prove to have been but a temporary reprieve.


Marjorie Curran, M.D.
MassGeneral Hospital for Children, Boston, MA.

No potential conflict of interest relevant to this article was reported.

This article (10.1056/NEJMpv1002319) was published on March 3, 2010, at NEJM.org.