An article by Tina DiMarcantonio in
ORTHOPAEDICS TODAY INTERNATIONAL 2007
MiST volunteers still offer care while they work to create a Level 1 trauma center in Pakistan.
A number of British surgeon-volunteers cared for severely injured patients in Pakistan after the October 2005 earthquake that destroyed hospitals and roads in Pakistan, Afghanistan and India.
The earthquake measured 7.6 on the Richter scale and lasted 73 seconds, taking 86,000 lives and leaving 120,000 injured. With a lack of hospitals and surgical experience in these countries, injured patients received little or no care before the British surgeons arrived.
“The local [medical staffs] had no time to apply external fixation or medical care to the wounds, and patients were left outside hospitals with no care,” said surgical trainee and volunteer Ihab Boutros.
British surgeons arrive
In early November 2005, the Mobile international Surgical Team (MiST) sent multidisciplinary teams of experienced orthopaedic and plastic surgeons to Al Shifa Eye Hospital in Rawalipindi, Pakistan. Boutros was among the volunteers.
“We went 4 weeks after the earthquake because of logistical problems,” Boutros said at the British Orthopaedic Association Annual Congress in Glasgow. MiST sent teams to Pakistan. Each team transferred patient care to the next team to ensure continuity of care.
When Boutros arrived at the small, local eye hospital with his team, they found 97 patients with 107 orthopaedic injuries. “On the first day we saw the patients, 72 patients [with 84 injuries] required immediate surgical treatment. The rest were discharged to camps because they had no homes,” Boutros said.
The surgeons found interesting demographics among the admitted patients, which included mostly women and children, Boutros said. Patients were a mean age of 34 years (range, 0.5 years to 80 years) with 34 patients younger than 16 years old, five infants and only five patients older than 60 years.
|
MiST surgeons performed an additional four amputations and revised 11 amputations when they arrived to Pakistan 4 weeks after the earthquake.
| 
MiST surgeon volunteers encountered injuries such as this open fracture when they arrived at Al Sharif Eye Hospital in Pakistan after the earthquake. They implanted external fixators in most cases and performed multiple washouts and debridements for all patients. Images: Khan S |
Lower-limb injuries common
Most patients presented with lower-limb injuries and significant soft tissue loss. Of the fractures, 64% were 3B open injuries, according to a study abstract. When the surgeons arrived, 12 patients had already undergone amputation.
Surgeons performed multiple washouts and debridements for the patients – 202 in total during their time there, Boutros said. They also performed 34 definitive orthopaedic procedures, 57 definitive plastic surgery procedures and 19 combined procedures.
Orthopaedic procedures included 11 Taylor spatial frame fixations, four Ilizarov frames, five open reduction and internal fixations, seven K-wire fixations, five manipulations under anesthesia, and two hip Spica applications.
Plastic surgery procedures included 21 split skin grafts, four amputations, 11 amputation revisions, 17 fasciocutaneous flaps, three musculocutaneous flaps and one free flap.
“The overall amputation rate reported by the Pakistani government was 3%, but from our sample – which you have to keep in mind is very small comparatively – the amputation rate was 18%,” Boutros said.
Because the government provided camps for the injured patients, Boutros and his colleagues did not follow their typical discharge protocol in order to admit more patients to the hospital.
“Even if the patient seemed to require care but did not require surgical care, they would still have to be discharged to allow other people to come in. We had to compromise on our standards,” Boutros said.
Future MiST volunteer work
The MiST team concluded their work at the Al Shifa Eye Hospital in December 2005, but they remain in Pakistan. Since April 2006, the group sent teams to Ayub Medical College in Abbottabad, Pakistan, every 6 weeks, according to Sohail Khan, FRCS, MiST co-director.
All fractures are either united or undergoing Ilizarov treatment, Khan said.
“Our long-term plan with the Pakistani government and private funding is to set up a Level 1 trauma and limb reconstruction center in Pakistan,” he told
Orthopaedics Today International.
MiST surgeons at the center will perform limb correction surgery using ring fixators. They will also teach the local medical and nursing staffs how to use ring fixators with the hope that they will eventually run the surgical center, Khan said.
MiST recently became the medical arm of Islamic Help-UK, a volunteer organization that provides aid to countries, including Lebanon, Mali and Indonesia. As the medical arm, MiST will provide medical advice and rapid response teams in disasters.
“Islamic Help has experience in providing housing, food and water in acute situations and water and other education projects in the long term,” Khan said. “If there is another disaster, MiST is ready to travel at a short notice.”
