Tuesday, 2 February 2010

Infections, long-term immobilization, severe malnutrition & dehydration

Sorry no update yesterday. It was one of my longest, most challenging days so far. The public health clinic was closed because it was Sunday, so I spent the entire day in the OR doing anesthesia.

It still amazes me that nearly 3 weeks after "the event" many with broken bones and large wounds are just now getting to the hospital for treatment. At this late timing, outlooks are poor and infection is rampant. I've never seen so many gangrenous limbs.

Anesthesia is difficult because no one will allow general anesthesia. No one wants to go to sleep. They are all afraid that we might amputate their legs while they are "asleep". Their fears are understandable (during the early response after the earthquake, out of desparation and lack of resources, many doctors had to resort to amputation to save the patient) and so, my skills in spinal blocks have gotten lots of practice.

I feel like I am working at the United Nations. In one case, I might have a surgeon from France, one from China, a circulating nurse from Thialand....oh, and an anesthetist from Illinois. It has really been remarkable to see so many people of such different backgrounds come together for the same united cause.

The hospital, though it has suffered severe damage, is one of the few hospitals in Haiti left standing. There are many great big cracks in the concrete and foundation and some parts of it have fallen, but just the fact that some of it remains "serviceable" is more than most other buildings surrounding the epicentre of the earthquake.

Aftershocks are still occurring, though I haven't felt any since I've been here, which makes working in the hospital a bit scary at times.

With so many hundreds injured and so much damage to the hospital, there is no room for patients. Instead, they have created "tent villages" to which patients have been assigned. Rows of tents fill the entire yard within the confines of the hospital gates. Tents are so close they are touching. There are so many sick people, it's often hard for us to locate patients within the tent village to be able to bring them to surgery. Patients have become identified by their tent number.

Pre-op and inital ER is outside too. There are even tents still set up as operating rooms outside from the first days when limbs were being amputated outside. Tonight I even ran a code on a women rushed in from the "village", her family yelling 15! 15! 15! (her tent #). She was carried to the outdoor OR tent, which consists of 2 large blue tarps and one dimly-lit ancient floor lamp. The OR table is nothing more than a slab of metal on blocks. It was really a disturbing scene; as if I was back in the Civil War era..,only this is 2010. Like nothing I could have imagined I would ever witness in my entire life.

This is Haiti right now. The scariest part is that this is not temporary and not going away any time soon. In fact, I'm afraid for the weeks ahead. I'm afraid of infections, effects of long-term immobilization, severe malnutrition & dehydration. While Haitian people are very peaceful and appreciative, in the face of hunger and starvation, people become desperate. I don't ever feel unsafe, though. People recognize the need for doctors & nurses and are extremely grateful for help.

I randomly ran into my Haitian friend, Frandy, at my clinic the other day! The world (& Haiti) is so small.


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