Thursday, January 28, 2010

Update #3

Another 30 hours gone

Wednesday was an incredible day. At 9 o'clock, Kate (a Nova PA student, also a Spartan), Lee (a Family Practice doc from Portland, OR) and I headed for the tent cty laden with supplies. We each carried full hiking packs full of medicines and supplies (80% Portland, OR, and 20% HC hospital) , and also candies, water and extra change of clothing (when you see the pictures, you'll understand).

As we were walking up to our clinic tent we could see the line of a couple hundred of people who were waiting in the already hot sun to be seen by us. Our arrival was greeted joyously by the wonderul Adventist group out of New York. We were able to set up a pretty good system based out of our main tent. Inside tent #1, there were 7 school desks against the wall which would be our desks. Each had a box of gloves, thermometer, penlight, small 2x2 inch pieces of paper (to be used as prescriptions) and a pen.

Seven university students who no longer had a school (as we were sitting in the destroyed remains and the tent city covered the remainder of the grounds) were there to act as translators. Mine was named Emmanuel. He is 26 and had been 2 weeks away from graduating with a law degree from the university. Now there are no records and he does not know what he's going to do.

Across from us stood 7 desks which would be our exam tables. On the other side of the tent was our dispensary and pharmacy. We would write prescriptions and then they would wait in line where two nurses were doling out medicines mostly for pain and antibiotics, but also blood pressure medicines, wound care, asthma meds, diabetic meds, skin cremes,vitamins, diapers and formula.

As we began to see patients, I grew suspicious of a possible outbreak as four or five children in a row all had cough and fevers to 101.8. I soon learned 2 very important things. First, everyone has a cough which I suspect is secondary to all the destroyed masonry and concrete, (akin to 911 pneumonitis). Secondly I learned the right way to take an armpit temperature with a mercury thermometer (something I have not used since I was 5 and my kids won't know what one is). It was 101.8 in our tent, and the kids were fine. I asked why we were in a shadeless courtyard instead of some large nearby shaded areas under overhangs and was told that the Haitians would not come into the tent under a building because they are so fearful of aftershocks.

We continued to see patients for 9 hours until closing at 5. If you think it's strange that a surgeon is running an urgent care clinic, keep in mind that the station on my left had a PA student, and the stations on my left had a dentist and then a foot surgeon. At one point when the heat got so bad, a couple of people set up shop outside, including a few hour stint by our inteventional radiologist, Mike Rush, and his son Tommy, a medical student. Lack of training or experience did not stop us from seeing over 600 patients. I estimate that at least 50% had no discernable problem but were merely hungry, scared and looking for comfort. To these people, we offered what we could. Kids who landed at my station got jolly ranchers or tictacs, and I was rewarded with lots of smiles.

The majority of problems that we could help with were respiratory infections, asthma, urinary infection, yeast infections, scabies, and aches and pains from untreated injuries. We had diapers as many people had not had access to fresh diapers for over a week. There was a lot of breastfeeding education as well. Haitian culture has not embraced breastfeeding, and even worse, many moms who had been nursing chose to stop after the earthquake for reasons I have been unable to understand fully. It seems it might be related to their religious beliefs.

Among the surgical things I saw were dozens of umbilical hernias in older kids (in the US we routinely fix them in all kids if they don't close by age4) and tons of fresh and infected wounds. Our foot surgeon is a ulcer/wound specialist so that came in very handy. She was able to start a wound clinic in one corner of our tent. I saw a couple of large inguinal hernias, and innumerable skin lesions, unfortunately, none were emergent enough to take back to the hospital with me. (And of course I forgot to bring my business cards :) ).

Finally at 5, dripping in sweat, and after giving our two volunteer translators some cash to take back to their families, Kate and I trudged with our empty backpacks back to the hospital. Empty backpacks, but full hearts as we finally felt like we had really done some good for the people who are suffering so badly yet deal with it so bravely, smiling and helping
each other.

Imagine our suprise when we got back to the warm smells of Chinese food. Our new friends from Portland had neglected to tell us that their Chinese American medical relief society is also a vegan group and during the day,additional members had brought in food and equipment and cooked enough vegan food for every employee, volunteer, and 1 meal per refuggee family. I will remember that meal for a long time, especially after one of our translators had managed to obtain a dozen bottles of Guinness ale. Their goal is to be up and running and cooking enough food for the entire hospital compound by Friday.

During the day we were gone, another group had built an entire new building approx 15 feet by 15 feet which will house water purification and treatment equipment to provide clean purified water throughout the hospital.

Many of the staff including the Holy Cross team were leaving Thursday morning to go back home, so Wed night we all pooled our supplies and had something of a last night campfire (we had French military ration kits which had solid sterno tabs for fire). It was at about this point that I realized I wasn't ready to leave Haiti. I finally felt like I had done some real good instead of just being a tourist who used his scrubs and stethoscope to come to Haiti and gawk. I decided I needed to stay another day and keep up the work. After a call to my wife (did I mention how wonderful she is), I told the HCH group I was going to stay. Kate, the PA student decided to remain as well.

Because I was staying and they were leaving, they did the night shift while I slept five hours. At as I went to sleep at the end of the 3rd day, I was pleased except for that faint nag because I still had not had the chance to do any surgery. Now, the inside of a Haitian belly looks the same as the inside of an American belly, but I came here as a surgeon. There had been a rumor of a possible bowel obstruction in the camp but a surgeon had seen it earlier in the day and decided it was stable. I woke up at 530 Thursdy to see the team off. I enjoyed a gorgeous Caribbean sunrise over the harbor (which we found out we could see if we climbed to the roof).

I also discovered that the bowel obstruction had worsened overnight and now needed to be operated on. A general surgeon from Georgia, Samuel Harden, had arrived Wednesday and he and I went to get the patient ready for surgery. I was very pleased that I was finally going to able to do what I came here for.

Now my first task was to find a fresh pair of scrubs. Every team that comes brings scrubs which they contribute to a communal box of scrub tops and pants. Their is a laundry team that has been cleaning the scrubs by hand so they are as clean as they are going to get. So by fresh, I mean, less dirty than the pair I had been wearing for about 24 hours. I went over dozens of used dirty scrubs in every shape and color until I came up with a San Diego green top and Chicago blue bottoms.

My next task was to evaluate the OR and the equipment we would have to perform major laparotomy a daunting task to say the least. They have one sterilizing machine, and I was able to pull together a mish-mosh of tools although we rarely had matching pairs of items. We were able to get cautery but not suction. We were lucky to have a new Anesthesia team from Rush University in Chicago and they did a great job. While many have heard stories of amputations being done without anastestic, abdominal surgery without general or epidural anasthesia is a whole nother ballgame.

There is a surgical mantra that, "the sun should never set on a bowel obstruction". This is because the longer you wait the worse it tends to be and tougher the operation will be. This should now be changed to, "the sun should never set on a bowel obstruction...except in Haiti". We ended up operating about 12-15 hours later than we should have, but thankfully were able to perform it successfully and get her to the recovery room without complications. Many thanks to Kate, who became the defacto scrub nurse because the 2 nurses helping us were regular floor nurses who had never been in an OR.

Full of enthusiasm following our successful operation, Dr. Harden and I toured the compound stopping at every area inquiring about belly pain, but alas we could find nothing to cut. We headed across the road to the clinic which had received all the Holy Cross supplies and found about fifty people lined up out the door and 5 docs (3 from Rush, and 2 from Portland) working tirelessly. I headed back to the hospital to sleep because I had volunteered to take the night shift knowing that I'm going home in the am.

My last little highlight of the day was when a UN truck arrived with supplies and I got to take pictures with the Sri Lankan Special Forces Paratroopers who looked like the fiercest warriors on the planet. Needless to say, I've met and interacted with a more diverse group of people in the past 4 days than any other time in my life.

I'm now off to bed for a couple of hours till the night shift, then I have to pack. I found a ride to the airport for Kate and I at 6am. Luckily, I don't have much to pack. My scrubs and socks stay here to be used by other medical teams. I've given away any remaining food to the Haitians, and I promised my sleeping bag, flashlights, and my second duffell bag to one of the translators I have befriended whose family is now homeless.

Thanks for all your warm wishes. If all goes according to plan, I should be in American airspace early Friday morning.


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