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SANJAY GUPTA MD
Haiti: Health Dangers; Impact on Health Care Reform?
Aired January 24, 2010 - 07:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, CNN ANCHOR: I'm Dr. Sanjay Gupta, reporting in Port-au-Prince, Haiti. Lots to cover today.
First of all, a revival ceremony going on behind me, some good news in the plaza (ph), some welcome good news needed after some time. A lot of discussion about aid over the last week. Medical aid, where is it? It's in the city, but why is it not getting to people?
Also, lots of tent cities cropping up all over the city, people who've been displaced from the earthquake are all fearful to go back into their homes. What is the real risk of a second wave of disease? We talk about it all the time. How likely is it to happen?
Plus, a new GOP senator from Massachusetts. What that could mean for your health care.
You're watching SG, MD.
(BEGIN VIDEO CLIP)
GUPTA (voice-over): We start, though, with the latest here on the ground.
Search and rescue efforts officially being called off now by the Haitian government. The UN says 132 people were rescued since the quake, and the first official death tolls. So far the government says more than 111,000 people have died, a staggering 609,000 people are displaced. We're going to have more on how that could impact health later in the show.
Also, a new hospital opening up here in the city. You may remember these images, Elizabeth Cohen reporting from a makeshift clinic at the UN compound. Those doctors from the University of Miami were able to move to this field hospital dubbed The University of Miami Haiti Campus Hospital. It's the largest field hospital in the country. It has 250 beds.
GUPTA (on camera): And also, these two men are two of the most renowned surgeons in all of Port-au-Prince, perhaps in all of Haiti. They're general surgeons, and they're twins. They're trying to take care of people - friends, neighbors, and they stayed open for business right after the earthquake happened.
UNIDENTIFIED MALE: I think it was the end of the world.
GUPTA: You thought it was the end of the world?
UNIDENTIFIED MALE: Yes.
GUPTA (voice-over): They are Haitian surgeons, Jerry and Marlon Bitar. Yes, they're twins. And, at this community, they're also heroes.
When the earthquake hit, they stayed open for business.
GUPTA (on camera): These are two of the most renowned general surgeons in Port-au-Prince and trying to do everything they can, obviously, for patients. But the problem is what happens - even if they provide the best health care they can with the resources they have, there is no plan after that.
The international community say, look, we're providing a lot of aid to Haiti. We're providing a lot of money, we're providing a lot of resources. What do you say to that?
UNIDENTIFIED MALE: We don't feel it.
UNIDENTIFIED MALE: Yes.
UNIDENTIFIED MALE: Today it's six days after - six or seven days. One week. Honestly, I don't say they don't send - bring, but I personally don't feel it.
GUPTA (voice-over): But today, they have far more pressing matters than worrying about when international aid will come. Hardly any food, minimal water and not enough pain medications. Patients are literally screaming for help.
GUPTA (on camera): The sounds that you hear over here are sounds that you never want to hear again. There are children screaming, knowing that they are going to have so much pain as they try and dress these wounds. There's not much they can do for them. It's not much in the way of pain medications they can give to them.
And then all of the patients waiting, knowing that they're next, knowing that they're going to endure that same sort of pain. It's impossible to watch.
Oh, wow. That's obviously a young boy who has significant injuries. You can see his legs, he's got - this is a - a severe scar and this has a lot of - a crush injury here.
UNIDENTIFIED MALE: Exactly.
GUPTA: This leg you've decided to - to save, though...?
UNIDENTIFIED MALE: No. We save that. We save that.
UNIDENTIFIED MALE: Yes. We save that. But this, we can't save it. GUPTA: So what do you do? I mean...
UNIDENTIFIED MALE: We have a lot of patients waiting here. They finish operating, but Dr. - while - I cannot go to the street because I don't have - I don't have home. And I think to help, I, you know, ask everybody who help to think about how to put - thinking about house.
UNIDENTIFIED MALE: (INAUDIBLE) yes.
UNIDENTIFIED MALE: They don't have a house.
UNIDENTIFIED MALE: You can't live without house.
UNIDENTIFIED MALE: Without house. They're on the street. And people, we give health care, they cannot go on the street. It's impossible.
GUPTA: And even near the end of the day, this is basically what continues to happen, trucks coming in with patient after patient after patient. This hospital is already full to capacity, but these two doctors are going to continue to take care of as many as they can.
GUPTA: Even shooting that piece with the twins, they kept telling us over and over again they're simply not getting enough medicines to be able to treat their patients.
What's going on here? We know medicines are in the city. Why are these hospitals not getting it? We're going to go find out. Stay tuned.
GUPTA: And, you know, this is something you have to deal with, and we're dealing with it right now.
DR. MARK HYMAN, VOLUNTEER, PARTNERS IN HEALTH: The lights just went out.
GUPTA: The lights just went out. And that's something that just happens.
HYMAN: We didn't have electricity until yesterday night.
GUPTA: You're in the middle of an operation - the doctors are in the middle of an operation and this happens. What do they do?
HYMAN: We brought flashlight. We are on...
GUPTA: Literally by flashlight?
HYMAN: Yes. We - we started with no electricity, no water and we did the first operation, which was an amputation, by head lamps, with a hacksaw that we cleaned with some vodka.
GUPTA: Head - a headlight, a hacksaw and some vodka.
HYMAN: That's right. Everything's log jammed at the airport, and the supply chain isn't working, so we're still without supplies, even though they're at the airport for us.
GUPTA: Do you have any idea why that is? I mean, because we're preparing that (ph)...
HYMAN: I - I think it's a logistical nightmare, and I don't know exactly why. Nobody seems to know why. And I think there's a lot of misinformation about things working and being operational.
A lot of people are getting things, but it's very slow, and it's --- these patients are really dying because we can't get the things that we have right here on the ground to us.
GUPTA: We're hearing that, exactly what Dr. Mark Hyman said, from so many people - people frustrated. They're trying to take care of their patients, but as Mark described, simply inadequate supplies, inadequate instruments. It's just taking so long.
We decided to go to the airport, look at the supplies and see if we can bring them out ourselves. Take a look.
GUPTA: It's like everywhere we go, just walking through the airport, even outside the airport people are saying we need supplies. How do we get them? We know they're in there, how do we get them out here? That's - people just keep asking me that same question over and over again.
All right. So now we're going to - go into the airport here and see if the next steps of this works or not.
We just take a look out here and all - all the people that are waiting. I mean, I can tell you that a lot of these people are waiting because they're simply hoping that some of these supplies make it outside the airport and to them.
OK. We're now in the airport. That took about five minutes to get in here. We're in the airport.
To give you an idea, I mean, obviously, the airport itself is - is still very, very desolate inside. But we're going to get to the air stripe. That's where we're hearing so many of these supplies are.
I don't know if you can hear me or not, but when we talked about all these supplies sitting here, just take a look. I mean, boxes and boxes of supplies, all kind of different formula in there, those antibiotics, pain medications, all sorts of different things.
I just want to maybe get (ph) some antibiotics.
UNIDENTIFIED MALE: I'll walk you over there and (INAUDIBLE).
GUPTA: Should we check in here first?
UNIDENTIFIED MALE: Yes. (INAUDIBLE) walk around to the (INAUDIBLE).
GUPTA: They seem very much like they want to help. I'm just going in to see if we can get some antibiotics, at least to try and take care of these kids and let's find out. There is a lot of supplies here, though.
We're able to basically walk into a couple of these tents, (INAUDIBLE) get what we needed and get lots of supplies here, lots of antibiotics, lots of pain medications, all sort of things, to try and treat some of the injured that we've seen.
These are medications that people haven't had up until now. It took about 15 minutes. We got a bunch of it, and we're going to try and distribute it to the hospital.
Basically, I just went into the airport and just tried to take as many of the things that we thought you guys would need, based on what the twins were telling us. So, some of this probably - broad spectrum antibiotics...
UNIDENTIFIED MALE: Very good.
GUPTA: Lots of different pain medications. All that screaming this morning?
UNIDENTIFIED MALE: Yes.
GUPTA: Hopefully you can...
UNIDENTIFIED MALE: That will take care of that.
GUPTA: Luckily (ph) we can help. All right.
UNIDENTIFIED MALE: Sanjay, thanks.
GUPTA: You're welcome.
UNIDENTIFIED MALE: Thank you.
GUPTA: So we came here today and we were able to pick up some of those supplies ourselves. We just for it and they gave them to us.
COL. BEN MCMULLEN, US AIR FORCE: Right.
GUPTA: I'm going to take them to that hospital and give it to them because kids and adults as well need this stuff today. Does that surprise you, what I just described to you?
MCMULLEN: There is stuff here waiting to be taken out. That's a true statement. Is it a lot? I can't speak to it.
I would tell you, the reason you probably got it is because everybody on this field, specifically the US government side, is dedicated to getting as much stuff outside as I - as they can. Does it totally surprise me that some are doing without? No, it doesn't. Not totally. Do I hope it gets better? Without a doubt.
We're doing our part to get things out there, and certainly get things into the airport, and it - and it is - it's a shame because you would hope that everything could get out there within seconds, but that kind of infrastructure just isn't in place.
GUPTA: The way - the way that it's working, obviously a lot of these supplies are getting to the airstrip. That seems to be coordinated pretty well. What's supposed to happen after that is people are supposed to come in with their identification, know the lot number of the supplies and go pick them up, take them to their first aid clinic or the hospitals. That's where it seems to break down.
There's not a central distribution point. There's - there's obviously all these supplies at the airport, but hardly anything else outside the airport in terms of distribution. And I know a lot of people are trying to work on fixing that.
You should also know the worst case scenario as well, antibiotics and painkillers simply left in the heat lose a lot of their - their potency or their efficacy. They don't really go bad, necessarily. Blood, however, left out in the heat without being refrigerated, that will go bad in about a day.
Now, it's been about a week and a half since the earthquake struck Haiti and many powerful aftershocks have followed. Our CNN correspondents have been all over the place, as you know, seeing first hand how lack of transportation and infrastructural leadership are preventing important aid from reaching Haitians.
And joining me now is my colleague, Ivan Watson. You've - you've been doing some amazing reporting, first of all, and I know a lot of people back home have been following you closely.
You - you know what we've been talking about with regard to aid, a lot of the aid being at the airport and not getting here to Port-au- Prince. That seems to be how people are measuring success, but you've been traveling outside Port-au-Prince as well.
IVAN WATSON, CNN CORRESPONDENT: Yes. We - we traveled about an hour and a half west of Port-au-Prince and there reached some - some towns and villages that say they haven't gotten anything, basically, since the earthquake.
And we spoke with one American missionary there from Missionary of Hope - Mission of Hope. It's based in Merrimac, Massachusetts. And she complained that there'd been no help with pulling bodies out. There are just some US marines who just arrived the previous day and they hadn't begun distribution yet.
The other complaint she had was that her mission helped bring in about four doctors who had given up their practice work and paid their own way down, and they have been stranded in Jacmel, that's a - a port on the south of Haiti, for two or three days, waiting for transport in. You know, you know how important it is to have doctors in. And she complained there just doesn't seem to be any leadership or organization for people to be sitting still like that, unable to help anyone.
GUPTA: When you drive to places like this, can you just describe for people - I mean, what - what it's like, what you're seeing outside, just as - is this countryside or what does this look like?
WATSON: Yes, I mean, it's - it's lovely. You got coastline here, mountains up in the hills, banana groves - villages, really. And then just mile after mile after mile of destruction. And as you get out of the city, these are one-story, concrete houses made out of cinderblocks and they are crunched, they're all collapsed on the ground and - and people are camping out there, too.
The population concentration isn't as dense, but the people are incredibly poor out there and now they've really been pushed to the brink.
GUPTA: They say even before the earthquake only 50 percent of the country had access to clean water. I don't - that's obviously gotten worse since this, but if people don't even have the basic supplies in these areas now for a week and a half. I mean, you can't - you can't survive without water for, you know, more than - I don't know, a week or so?
I mean, are - are people dying just for lack of water, food, things like that?
WATSON: As it was explained to me by a nun yesterday, these people were living below the poverty line already. They were desperately, desperately poor, and now, they have - whatever little things they had - they have nothing.
Now, I have to suspect that out in the countryside, maybe there are some more coping methods, as in people can - can fish in the sea and - and there is some agriculture going on there, and maybe that will help them a bit in the way that you - you don't have those resources for the urban dwellers after this disaster.
GUPTA: All right, Ivan. Amazing work. You know, we'll be - we'll be here all week as well, so hopefully we'll get a chance to chat like this again.
We want to give you some news back home as well. There is a scramble going on, as you know, to figure out the future of health care reform. Dead or alive, we're going to checking in after the break. Stay with us.
(COMMERCIAL BREAK) GUPTA: Welcome back to the program. I'm Dr. Sanjay Gupta in Port-au-Prince, Haiti.
You know, we've been covering health care reform as well since the president's inauguration a year ago. It seemed on the verge of passing, and on this week, there was a stunning blow, as I'm sure you know, Republican Scott Brown was elected in Massachusetts. What does this mean for the proposed health care bills?
Our Congressional correspondent Brianna Keilar has what's next.
BRIANNA KEILAR, CNN CONGRESSIONAL CORRESPONDENT: Sanjay, that come-from-behind victory that put Republican Scott Brown into the Senate seat that was held by Teddy Kennedy in Massachusetts for decades, it has just thrown Democrats into utter turmoil when it comes to what they're going to do about health care reform.
Because of that election, Senate Democrats no longer have that 60-vote filibuster-proof majority that they've been relying on to move health care reform through the Senate, and because of that, it seems the ball is very much in the court of the House of Representatives.
We've been paying a lot of attention to what House Speaker Nancy Pelosi has been talking about as the way forward. She closed the door on the idea of the House just passing the Senate bill outright and putting it on President Obama's desk. That seemed like the easiest route to go.
But some of the other ideas, one being taking the Senate bill, changing it a bit and using a procedural tactic that would allow the Senate to just rely on the simple majority of 51 instead of 60 votes to pass it. The issue with this for Democrats is it would be a huge political risk. You would have Republicans saying that they're doing something under the radar and it's not on the up and up.
And so it seems like, lastly, their option would be to take some of the items of health care reform that do have some broad report - broad support, try to get some Republicans onboard, pare down their efforts and try to move that. Maybe they could salvage some items like telling insurance companies they can't deny coverage on the basis of a preexisting condition or telling insurance companies they can't cap benefits for Americans, either over the course of a year or over the course of a lifetime.
Maybe there would be something in there that could encourage people to get insurance but not outright demand that they do it, and, because of that, there would also have to be some assistance in the form of subsidies to help low income and middle class Americans get health insurance.
All of these details unclear at this point as Republicans really lick their chops over this new-found influence they have on health care reform, Sanjay.
GUPTA: Brianna, obviously so many details still to work out. It's going to be fascinating to see how this turns out. Brianna, thank you so much.
We are - we are going to continue to drill down what health care reform could mean to you, and tune in for that, obviously, in the coming week in the show. We're dedicated to this particular issue.
We're also dedicated to continue to cover what's happening here in Haiti. Behind me, a revival ceremony of sorts, obviously a - a good sight, in many ways, a very different from the sight we've been seeing for - for weeks now.
One of the signature injuries of this particular earthquake is probably going to be something known as crush injuries. What are they exactly? What happens with them and how do doctors treat them? We'll have that after the break. Stay with us.
GUPTA: Pictures like that one are - are really what keeps so many people going around here. The last rescue we're aware of, a 22- year-old man rescued yesterday after being buried for 10 days. He was pulled from the rubble by an Israeli team who says he is in stable condition at their field hospital. Luckily, he had some access to water, but still remarkable, extraordinary rescues.
Most rescues are just the beginning. I have to tell you, the medical care - the sort of people get after that, very important, and crush injuries, rubble actually falling on peoples' limbs. That seems to be one of the signature injures of this earthquake.
What happens with these crush injuries is that the muscle starts to release these toxins known as myoglobin. Those toxins get into the bloodstream. They can often shut down the kidneys. They can cause very high potassium levels. They can also cause cardiac arrest.
So it becomes this really difficult decision for doctors, do - do you keep a limb or do you amputate? And sometimes it's a dramatic decision that you say you have to take a limb - an arm or a leg in order to save a life, and that is something that is happening so many times. We've seen this happen in field hospitals, some of these amputations even being performed in the plaza right here behind me.
Another thing that we talk about a lot is the second wave of disease after large disasters. Does it really occur? Well, I went to tent city with thousands of people to see how likely that would really be.
GUPTA: And we're here with Tanya (ph). She's a little baby, two-month-old. T-shirt's cute. It says "Does this diaper make my butt look big?" She's living here with four other kids, (INAUDIBLE) adults. This is their home. This is a tent. This is what it's like to be displaced after the earthquake.
Just everywhere you look there are tents like this. And this is one of the things that people are most concerned about when they talk about a potential second wave of death. They're worried about infectious diseases, in part because of the living conditions like this, people living in very close quarters. There's a concern, could you start to spread diseases like (INAUDIBLE) to spread respiratory illnesses.
And what about the water? Is the water clean enough to actually prevent waterborne illnesses as well? Take a look over here. They did a pretty good job here. They have clean water. That's really important. You have clean water and you can solve a lot of problems.
For the most part, if you talk to public health officials, they'll tell you that the idea of a second wave of death due to infection is probably overblown. Actually, it probably doesn't happen that much (ph). In fact, if you control some very basic things, including water, making sure they get that, and including access to some good, clean food, you can probably stave off a lot of these potential infections.
Keep in mind, we are talking about Haiti here. Even before the earthquake, about 45 percent of people did not have access to clean drinking water. And, of course, this is how they're living, in very close quarters. If a disease outbreak was to occur, it could spread very quickly from person to person.
One thing that's important to notice as well is how hot it is out here. It is just hot. Forget about infectious diseases, forget about (INAUDIBLE), forget about hepatitis A, worry about the heat. People are at real risk of having heat stroke if they simply don't get enough water.
Another concern people hardly ever think about is that all the aid workers that are coming to this area, well, they need to be inoculated as well. In fact, as journalists, we get these immunization cards to make sure that we don't become the carriers and the cause of a big infectious disease outbreak in a place like this.
But, again, this is tent city. People live in close quarters, people are concerned, certainly, about infectious disease outbreaks. As things stand now, the - the likelihood of that seems pretty remote.
GUPTA: And they're probably going to be living like that for some time to come. As you heard, there are hundreds of thousands of people who've been displaced and there are some plans to try and relocate them over the next several weeks.
You know, when I came down to Haiti more than a week ago now, I didn't really know what to expect. I expected there would be a lot of desperation. There might even be some violence because of that desperation. Instead, what I saw was a lot of people really have been generally respectful of each other.
I want to show you an image here, if I could. This is an image that I took with my - with my camera of people waiting in line for water. Now, keep in mind, this has been several days after the earthquake. It was very, very hot outside, and there was no pushing, there was no shoving, there was no armed guards. Instead there was a lot of dignity, there was a lot of respect for one another as well. And that's an image that I'm going to keep with me, and it's an image that I hope you keep with you as well.
Much more in-depth coverage on Haiti. Stay tuned.