FRISCO - Dr. Peter Janes recently treated amputee patients amid the cracked walls of a Haitian hospital in makeshift operating rooms: "I'm still fixing femurs in my nightmares," he said.
The orthopedic surgeon with Vail-Summit Orthopaedics in Frisco returned last week from a volunteer trip to help people suffering with crushed arms and legs.
Patients, untreated for two-and-a-half weeks, waited in tents outside a Port-au-Prince hospital as they were wheeled or carried up three floors to operating rooms.
Dr. Anthony Brocato, an anesthesiologist with the group, said there were no cases of head or chest trauma.
"I'm sure they're out there, but most of those people probably died," he said.
The group returned Feb. 1 from a week-long trip to the country that was hit by a 7.0 magnitude earthquake on Jan. 12.
Matthew Cowell, a certified registered nurse anesthetist, and Kate Hamzi and Patty Janes - both registered nurses - were among the group. All of them work at medical offices and St. Anthony Summit Medical Center in Frisco.
The 18-bed Port-au-Prince hospital, one of only three hospitals in Haiti's capital, had sustained significant damage.
"The patient rooms were considered not safe at all, so all the patients lived outdoors on the ground," Janes said.
Two operating rooms had made it through the quake with minimal damage, and three makeshift operating rooms were added.
The team of Coloradans focused on orthopedic work, one of the most immediate needs. Members of the group often found themselves helping with tasks outside their specialties.
"It helped that we had all worked together before," Brocato said.
The volunteer group arrived to offer assistance not long after medics from elsewhere departed.
"Groups before us were doing what are called guillotine amputations," Janes said of an operation that cuts limbs straight off. "It doesn't leave anything for the next person to close. Some were infected."
The guillotine amputations don't leave much skin to close over the stump. Janes had to cut further into some patients' stumps to close the wounds, prevent infection and make the limbs more accommodating to future prostheses.
He said several medical teams came to help the Haitians, but the inconsistency of such treatment made things somewhat chaotic.
"There's this continuous transition of people and treatment," he said.
Janes said that considering the two-and-a-half weeks it took for care, many of the patients are likely to develop infections.
"I predict a second round of amputations this coming week," he said.
Brocato said he'd heard stories of amputations occurring when the patients had nothing more than ibuprofen for dealing with the pain. He said the group brought plenty of supplies to help their patients, but the strategy was a bit different from back home.
He said general anesthetics - involving reversible loss of patient consciousness - were generally avoided because the patients would be returning to tents afterward.
"We didn't feel comfortable taking somebody to a tent who was hardly awake," Brocato said.
There wasn't enough room in the tents for some of the patients, who had to make do outdoors.
Spinals and nerve blocks were used to help with pain, and it wasn't uncommon for a patient to be awake while his or her foot was being removed.
All the local medics said the Haitians' capacity for pain tolerance was remarkable. Janes said children and adults would be stoic as they were moved with broken femurs from one table to another.
Brocato said perhaps their resilience had something to do with their background.
"These people hardly had anything through their life, and now they had nothing," he said. "So I'm not sure that complaints would have gotten them very far."
The team saw about 30 cases per day.
While amputations were common, the birth of a baby helped raise morale.
"In the midst of this chaos, here's a C-section," Janes said.
Brocato said the birth made everyone happy.
But some parents wanted to send their children away from Haiti.
"One mother was a single mother of six. We had to amputate her leg," Janes said. "She asked staff to take her two youngest children."
The Haitians have many years of recovery ahead of them, as structures ranging from hospitals to the president's palace had collapsed.
"The destruction hits you right away," Janes said of the scene as the group stepped off the plane.
Brocato added: "And chaos; there's a lot of chaos."
Janes said it was remarkable there hadn't been any crashes at the airport, where military planes and "big jets" were taking off and landing all day.
People from across the world - including Brazil, Italy and France - had camps set up to provide relief to the Haitians.
Haitians in the streets had written on walls and signs: "We need help."
But the doctors said there was no violence other than the occasional gunshots at night.
"The roosters at 3 a.m. and the dogfights were worse," Janes said.
The group did not travel at night, as they were told it would be unsafe.
Several parks were full of tents dwelt in by people with no place else to go.
"Fifteen years ago there was a homeless population living in tent cities, small populations," Matthew Cowell said. "But now that is a hundred times multiplied because the middle class - because of the destruction of their homes and stuff - are now living in the streets as well."
Cowell said he'd visited Haiti about 15 years earlier, when he was in the U.S. military.
"That was some of my motivation to go back, because I knew what an impoverished country that was," he said.
He said the earthquake destruction was unimaginable.
"If they do it right, there's a chance to rebuild the infrastructure from the ground up. That would be the best thing to help poverty and everything else," Callow said.
Robert Allen can be contacted at (970) 668-4628 or firstname.lastname@example.org.