By Ken Carlson
Modesto Bee
March 6, 2010

As a veteran emergency and intensive care nurse, Marti Smith of Oakdale has cared for plenty of car crash victims and other people with severely broken bones.

During her 10 days of serving on a hospital ship caring for victims of the Haiti earthquake, she wasn't struck by the severity of the injuries, but by the sheer number of Haitian people with severe trauma.

Smith volunteered last month on the USNS Comfort, a Navy hospital ship anchored near the capital city of Port-au-Prince.

She was part of a seven-member team assembled by the California Nurses Association. She has worked as a registered nurse for the former Stanislaus Medical Center, Memorial Medical Center and Doctors Medical Center, where she is now a labor representative for nurses.

Smith only caught a glimpse of the devastation in Haiti, where a 7.0 magnitude quake Jan. 12 caused 280,000 homes and other buildings to crumble, killing more than 220,000 and injuring many more.

But what she did see was disturbing.

After landing in Haiti, her team and 48 other nurses caravanned with a military escort from the airport to the harbor of Port-au-Prince. Through the bus window, she saw damaged buildings, thousands of people crammed into a tent city and families living under tarps along the street. It was a 20-minute boat ride from the port to the ship, where she stayed for the duration of her service.

Smith worked in the ship's emergency department, cleaning wounds and starting intravenous lines for injured people brought by helicopter and boat.

Medical system 'destroyed'

More than a month after the earthquake, teams of neurosurgeons, orthopedists and pediatricians from the USNS Comfort were going ashore to poorly equipped hospitals and clinics to find patients who needed additional treatment.

Many of the injured had broken bones that were not aligned, others had undiagnosed fractures, infected wounds or untreated medical conditions.

"The country's medical infrastructure was destroyed," Smith said. "A lot of people were in outlying hospitals and other facilities that didn't have enough supplies."

The ship's emergency room received 40 to 50 patients on busy days, all of them with serious injuries or illness. The nurses prepped them for surgery or admitted them to the open hospital ward, where patients rested in bunk beds.

Smith worked 12-hour shifts for nine of the 10 days, with one day off, but had no complaints. The ship's military staff was exhausted from working 21 days straight.

The nurses saw incredible cases of healing and forged bonds with Haitian patients that will stay with them for life, Smith said.

One was a Port-au-Prince police officer named Roosevelt. A wall fell on him during the quake, injuring his neck and causing him to lose sensation in his feet.

Co-workers rescued him and brought him to a clinic. Although he was barely able to walk, the clinic workers simply gave him ibuprofen and sent him away, Smith said.

For a week, he had severe leg pain. He went to another clinic, where an X-ray revealed a fracture to the C-5 vertebra in his neck. Such an injury can make it hard to breathe and often renders the patient a quadriplegic.

Taken to the USNS Comfort, Roosevelt underwent surgery to fuse the vertebrae and stabilize his neck. He was determined to recover so he could provide for his 3-year-old daughter and pregnant wife.

After several days of therapy, Roosevelt was discharged and went home.

"It was quite something to see him walk out of the hospital ward and go home," Smith said. "It was nothing short of a miracle."

Equipped for most surgeries

The USNS Comfort has capacity for 1,000 patients and was filled upon arriving in Haiti a week after the quake. There were about 200 patients during Smith's service Feb. 15 to 25.

The ship has state-of-the-art intensive care units for adults and children, and 12 operating rooms equipped for any surgery, except organ transplants and coronary artery bypasses.

People from one of the poorest countries in the world — some with complex head and facial injuries — were treated by some of the top names in neurosurgery and orthopedic surgery, who donated their time on the ship.

"Some of the doctors were star-struck by these surgeons, who were at the top of their field and had written books about orthopedic surgery," Smith said.

One of the nurses' favorite patients was an 8-year-old street child with a rare condition that made his skin allergic to sunlight and caused cancer to break out on his skin. The cancer had spread to his right eye and people from the orphanage where he stayed brought him to the USNS Comfort. Surgeons removed the eye.

"When he came to us, he was almost like a feral child," Smith observed. "He would not eat or allow people to touch him."

The nurses called the unidentified child Johnny D., short for John Doe, and a Red Cross translator became like a mother to him. After a week of interacting with the nurses, the boy started eating and talking. He soon was helping push gurneys and wanted to fist-bump everyone, Smith said.

Smith cared for him when he needed sedation before changing his dressings.

"He climbed right up on me, and I gave him the shot he didn't like and I just held him," she said.

People from the orphanage, the Mission of Hope, came on board to see him and agreed to take him back to the orphanage. Smith, who returned home last week, is trying to contact the orphanage to see how he is faring.

Disease spread a concern

The Haitian patients did not complain or ask much of the nurses, she said. The nurses had to offer them pain medication, which often was turned down.

The medical teams were concerned about the spread of diseases such as measles and hepatitis; every patient who came aboard was given a mask as a precaution for tuberculosis. Foreign relief workers are instructed to have a TB test three months after returning home.

Before going to Haiti, Smith had seen only one case of tetanus in her 16-year career. But a half-dozen Haitians on board were stricken with full-blown tetanus, a disease prevented by a routine vaccination. Tetanus causes spasms triggered by any stimulus, such as turning on a light, making the muscles extremely rigid.

Because the disease can result in lockjaw, closing the airways, the patients needed to have breathing tubes inserted. Although it is treated with antibiotics, the disease claimed the life of a Haitian girl.

The medical needs will be tremendous in Haiti for months and years to come, Smith said, citing the large numbers of people with amputations and other disabling injuries.

The California Nurses Association's RN Response Network has 12,000 members willing to respond to Haiti. But many areas of the country are not entirely secure.

"We are talking with nongovernmental organizations to find safe places for our nurses to work," Smith said. "I would go back in a minute."