Monday, March 1, 2010

Clinic under a tent

Clinic under a tin roof

Story 2

We had just closed down clinic and were getting ready for a nice relaxing evening. Clinic had been around 300 patients. We were tired; our team had little sleep from our all night C-section the night before. Suddenly down the lane came a truck. As it screeched to a halt I ran up to see what all the commotion was. In the back of the truck was a man with an obvious femur fracture. My heart sank because our friends from next door, who had an orthopedic surgeon, had just told me that the Hospital generator was out of gas and there were no more surgeries today. We called them and they showed up in about 10 min. Mean while I told our people to not take the man from the truck because if we did the truck would leave and we would be left the man who needed surgery and no way to care for him. The orthopedic surgeon arrived and examined the man. It just so happened that the Spanish Navy doctors were still on the grounds looking after a lady who was delivering a baby. We called them over to have a look as well. They said they could take him to their ship and fix his leg but we needed to stabilize the fracture. So off people went to find splinting material. Soon some 6 inch wide fiber glass splinting material showed up. Some morphine was given for pain. Then with someone holding the man’s arms and trunk and someone holding his hips the orthopedic surgeon reduced the leg and placed a full length splint on it. About that time the Spanish medic hummer showed up. A stretcher was placed under the man and in the medic hummer he went. Thank God for the Spanish.
Well maybe now we can relax and get some supper.

Story 3
The Haitian Government had announced that Friday, Saturday and Sunday would be days of prayer and fasting. So clinic was slower and a nice break. We had time to work on cleaning the pharmacy and cleaning instruments that we had used through the week. But as normal just before dark a young woman came in with dehydration and fever. So everyone worked hard and fast to start IVs and get antibiotics started. As that was happening a group of men came up. One of them had been hit in the face with a large rock. Blood was running from his face, mouth and nose. We laid him on a table and began to examine. One of our volunteer medical staff was a retired Neuro Surgeon. He was able to examine the man and found that he had a Laforte 3 fracture. That means his cheek bone was shattered with the involvement of the lower half of the eye socket and the roof of the mouth. Again we had no means to care for this man. We contacted the University of Miami MASH Hospital in Port au Prince and made arrangements for the man to go there in the morning. He had no sign of spinal fluid leak and was alert and oriented so IV fluids and pain meds for the night. But before we were done here came a 10 year old boy with a closed forearm brake of both bones. He looked like he had an extra elbow. We have no x-ray, so we did our best to set and splint his arm and gave him pain medicine for the night and sent him for x-rays in the morning to a local hospital.
Now we did all of this under a tarp in the dark with flash lights and head lamps.

Story 4
We had been short staffed today. One doctor, Dr Johnson, an American surgeon and missionary to Kenya with World Gospel Mission, Helen a retired missionary nurse to Haiti and me were the only missionary medical staff at the clinic. So we told the Spanish that they would be doing clinic and we would run the pharmacy and cover the late shift. So Helen ran pharmacy all day and I did crowd control. We had to turn people away but gave out cards to see them first in the morning. As we surveyed those that we were sending away one lady just looked sick. So we questioned her and discovered she had had diarrhea and vomiting and fever for several days. So we laid her on a cot under the banana trees and started IV fluids and antibiotics. After 2 liters of fluids she felt much better. Meanwhile, two ladies showed up - one had had a miscarriage and needed a D&C and the other one who was 5 months pregnant started bleeding and had not felt the baby move all day. So after Dr Johnson examined them we set up our labor room for a D&C and informed the family of the other lady she needed to go to Port au Prince to a hospital with an OR. She might need to have surgery if she bleeds out. She also needed to have a blood transfusion. For the D&C I gave pain meds and versed and monitored the patients breathing. It went well. Now to the lady that needed transferred. First of all we had no vehicle and so we asked the family to get a car and take her. They said they did not have money for the gas and could she go in the morning. Of course by now it is dark again and only flashlights. So began the usual barter of how to get the lady to the hospital. Finally it was decided to call the local ambulance. Now I use the word ambulance lightly. It is a Land Cruiser with a stretcher in the back and a driver. You have to pay the diver and then pay for the gas, so again bartering. I must confess that I was losing my patience. I told them you’re messing around to see if you want to pay $15 for gas and she is going to die. That seemed to get their attention and they came up with the money. I paid for the driver and the family paid for the gas. Now it was close to 11pm. So she was loaded into the ambulance and off they went. Maybe some rest, but no, here came a family with an unconscious man. They laid him on the table under the big tarp. I got my flashlight and went to see him. They had found him this way and he had not been sick. So I began to examine him. He had no reaction to pain or babinski reflex. He blinked his eye when I touched his eye lashes. Other than that he stared ahead and made moaning sounds. His symptoms were bilateral so my gut feeling was he was not a stroke but most likely post seizure. So I went to wake up Dr Johnson. By the time we got back the patient was waking up. Then sure enough he started having a seizure. Michael a young man and first responder from Tennessee working with Aid For Haiti ran off to find valium injection. After 20mg of valium IV the man settled down and seemed to stabilize. Unsure of whether this could be meningitis or not we load him up with antibiotics and ourselves with prophylactic Cipro. We loaded up more valium and gave the Haitian night nurse instructions on how and when to use it. Finally rest at 1230 to 1 am. Through the night he did have more seizures. So in the am we referred him to a hospital in Port au Prince. His family showed up with a motorcycle and loaded him on, the driver, the man (still seizing) and two women to help hold him on. This is Haiti!! We just hoped they would not wreck before they got over the mountain because we did not want to have them all come back for treatment.

Mode of transportation for medical team

US Military helped at the Wesleyan Clinic

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