This week has been a busy one. We have several patients that will probably be coming often to see us. One is the man I talked about last week with the burns on his back. He didn't return for a week and we didn't know where he lived so couldn't send anyone to get him. Then one day a neighbor saw him and told him he needed to come back to the clinic. He hadn't wanted to come back because we hurt him too much. We tried to explain that if we didn't get the old skin off his burn it would get infected and would scar very badly and limit his arm and head movement. I'm not sure if we got him convinced or not but he did come back on Friday. We saw him on Thursday evening and his burns no longer had a dressing on them and he had rubbed ashes on them. I'm not sure what the ashes were supposed to do but they didn't help matters any. Of course his back was very dry again so we had to put more cream on it and told him to come back on Friday. We got the wounds partly cleaned up but still the skin wasn't ready to come off and we don't have anything here to scrape it or cut it off with. So once again we put a bunch of cream on and a big dressing and we will try again on Monday. If he doesn't come this time at least we know where he lives now so we could send someone after him. We don't have a lot of  pain medicines that are adequate for a procedure like we need to do on him but we do have a medication that we can give him IM. (Intramuscular) even with that he is in tremendous pain.

     On Thursday we had a patient come with an injury to his arm that was supposedly pretty bad, it was wrapped in several towels that we could see. I took them off and saw a big bloody mess. He had a wound from his wrist almost to his elbow that was very bloody and wrapped in some plastic. We asked what had happened and they said he had fallen from a tree onto some roots. I have never seen roots that could cause a cut that big so I started working on cleaning this thing up to see what was underneath while someone else continued to question the family. Finally they said he had fallen out of a tree onto a machete.... Ok.. Are we going forwards or backwards with this story???? To skip ahead a little we afterwards found out this man was in a fight with his cousin and this wound was from a machete... And it had happened the evening before so now this wound was 18 hours old and it's dressing was some plastic and towels. This cut was deep and needed an operating room but instead we did the best we could. I honestly didn't know if we would be able to get the edges of the wound back together but with numerous people and instruments that we had we got it. We put several dissolvable stitches inside then started to sew it up. We had to use hemostats to pull the edges together and hold them there until we had enough stitches in to hold it together then we would move ahead about one inch and do it again. Thankfully the shot we had given this man worked well. We had him on his stomach on the table because the wound was at such an awkward angle to do anything with otherwise and this man fell asleep for a while. It took us at least two hours to get his arm sewed. up and there were 40 stitches on the outside. We did give him 2 liters of IV fluids while we were stitching because I'm sure he had lost a lot of blood already and then when we cleaned the wound it started bleeding again and even with a tourniquet on his upper arm tightly it was a steady drip, drip of blood. We sent him home with antibiotics and ibuprofen and when he came back the next day his arm looked good so hopefully it will tomorrow also. Back in the states this guy would have had to have at least one surgery if not multiple and I'm sure he would get IV antibiotics for several days for sure. We do not know how much this man will be able to use his arm in the future but we are hoping it won't have to be amputated.

     In Creole class I am trying to get the structure of a sentence figured out. I think the rules are easier than with English but I do not have it figured out yet.
    Today was time change here also. We still had church the old time. Next Sunday is Trevor and Mirlene's wedding so we are hoping everyone gets their time changed before next Sunday. It's just much different when the only clock a person might have is their cell phone. Time has a totally different meaning here than in the U.S. The time doesn't matter that much, you get up when the sun is up and go to bed when it goes down. These people probably have some candles in their houses but very few even have a kerosene lamp.
                 Bon swa! (Good afternoon)