Haircuts... At work

   On July 18 we had an eye doctor come to our clinic to look at eyes (duh) and find candidates for cataract surgery. We let them use one of our exam rooms. It really didn't turn out to be as hectic as I thought it would be. One thing that helped is that we had totally separate waiting areas for eye doctor patients and regular clinic patients. Usually our slower days are Tuesday and Friday but not that day. We were there until almost 5:00 and the eye doctor team was probably there until 7:30. Eight people were selected as good candidates for surgery which will probably be done in October.
   An 11 year old girl came in that day. She was limping but didn't have any crutches or anything to help support her weight. Her lower part of her leg is broken and has been for three months. Now it has several pieces of bone sticking out. Initially there wasn't even any skin broken but I guess over time some shards of bone are working their way out. Her family took her to the hospital sometime after it happened but finally left because she was never seen. When they asked when she would be seen the answer was always "tomorrow".  Now it is infected and still very swollen.

We gave her some  antibiotics to try to get rid of the worst of the infection while we try to find a doctor who will examine the leg thoroughly before just doing an amputation. That is what we are afraid would happen if we just sent her down now.
    Today we had another young child come in with cholera. He was unconscious but not as dehydrated as the little girl we had several weeks ago. The vomiting and massive amounts of diarrhea from cholera can kill a person in a few hours if it is a bad case. We put him on IVF's right away and tried to give him some medications for vomiting etc. but they came right back up. Several hours later he was able to keep down some pedialyte. We kept him several more hours on IV then sent him home with instructions to force fluids tonight. He was still having some diarrhea but was keeping fluids down so we are hoping for the best. This morning when his mom brought him in she mentioned she also had a younger child at home who also had diarrhea. So we told her we would take care of this child, she needed to go back home and bring the other child in too. This little boy had reddish hair from malnutrition and little braids that had obviously been done quite a while ago because it was pretty matted. He also had some fungus on his head. Then he threw up and that got all over in his hair too so Luanna got out the scissors. He was quite a cute little boy with a haircut. I was afraid that the mom would be really upset but when she saw it she just said " thank-you". I had really wanted to cut it but didn't quite have the nerve. When mom got back with the other child she didn't look bad at all. She had had some diarrhea but no vomiting and was still breast feeding well so we didn't even start an IV on her, just encouraged oral fluids.
   The other day I did have to give a little girl a haircut though. She also had nice little braids but then had a large open sore on the top of her head and smaller sores scattered all over. I asked her mom though before we did anything and she agreed that it would be the easiest to treat if we cut her hair.

Drama...

  The young man that broke into our house has been caught and is in jail. But that story can't come quite yet. First I need to tell you all how it came to be that he rode in our vehicle part of the way back to Oriani.
  Last week we had a young man carried into the clinic. His lower body was covered with a sheet but we could smell that he had wounds somewhere. This man fell out of a tree last October and broke his back. He was in the hospital in Port for a while but about six months ago the hospital he was at had some kind of drama about a policeman getting shot there and all patients who were able to leave were told to leave. He was brought back to his dad's house which is about a thirty minute drive away from the clinic. He is paralyzed from about his mid back down, has large pressure sores on both of his legs,   and hasn't had the care he needs. His mom is dead. From looking at his back I didn't think he would even be able to sit up. Anywhere he goes he has to be carried. If he had a wheelchair he couldn't even use it on the path leading to his house. It is much too narrow and uneven. Apparently the family has been paying someone quite a bit of money every eight days to come to their house and change this boys' dressings. The dressings that were on his wounds were pretty pathetic.

Lots of some kind of powder had been put in the wounds then a small amount of gauze then scotch tape all the way around his legs to keep the dressings in place.  This man is just skin and bones so I'm sure he wasn't getting proper nutrition, especially not enough protein for wounds to heal. The family had finally run out of money to pay this "nurse" or whatever they were so brought him to us. We wanted them to bring him back in a couple of days but just his dad came and said they were unable to get a machine to bring him that day and he is unable to come on a moto or mule, what should they do? We said they should just bring him the next day. That didn't work out either so we decided we would go to his house this time to do a dressing change. So Trevor, Mirlene, and I and Luanna (a girl who is here observing at the clinic for seven weeks prior to med school) got in the machine along with a local man who knew where this man lived. The road came pretty close to this man's house. We only had to walk a couple of minutes. We found him propped in a chair outside the house.  His dressings were very dirty and partly off. There were maggots crawling in the wounds and out from under the dressings. Flies were everywhere.
    By this time most everyone in the community knew who had broken into our house. Just the evening before he had been seen coming back up to Oriani so a warrant was written for his arrest. The man (Andres) who had come with us to tell us where to go had heard that this thief was in a small town close by so while we were changing dressings he went to look for the thief. We finished and had driven back through the market and were waiting in the machine only a few minutes when a big mob of people come up to the vehicle. After several phone calls and much hollering and discussion  Andres and this young man get in the vehicle and we take off. Trevor and Mirlene are in front and Luanna and I had gotten in the back. We decided whatever was gonna happen in that middle seat could happen without us. Several miles down the road we meet a moto (someone that was called to help) and one of those guys gets in on the other side. Then the real hollering starts! The young guy never denies he was the one to break in at our place but wants to know "Who saw me?" Several more miles down the road we meet another moto that flags us down. It is decided they will take this guy the rest of the way on moto so they all climb out. He tries to run then so is very quickly tied up. We decide they can handle the situation from here on so head back to the clinic where we have many patients waiting for us. Later that day the police come and get him and take him to jail. Is this whole thing over? We don't think so, not yet anyway... But it made for a very interesting day!

"A loaded kamyon has tipped over and there are a lot of people hurt"

    This was the phone call we received while we were in the forest Monday evening for a wiener roast. The accident happened only a few miles from the clinic. A kamyon loaded with potatoes, onions, and cabbages and then people riding on top of that was in too high of a gear climbing a hill. I guess the truck stalled then started rolling backwards down the hill. The only way to stop was to turn the wheel. Anyway, the whole truck tipped over.

There were probably 20 people altogether on the truck. We arrived to see sacks of vegetables strewn all over. Some of the passengers had been carried to the ditch bank and some were still sprawled amidst everything. The only lights were from a few flashlights then lights from people's cell phones. One patient was not doing well at all and we quickly realized that we would be unable to help her. She was a pregnant mother who had no obvious injuries but had either internal injuries or a head injury. She was breathing very sporadically and had a barely palpable pulse so we went on to others. There was not a lot of blood and no obvious broken bones. One lady quietly told us she thought her neck was broken. She couldn't feel or move her legs at all. She had already been carried to the bank but we tried to impress upon everyone close that she should not be moved at all! Everyone seemed to understand so we moved on. The ambulance wasn't there yet so we had no stretchers available. Another man was drunk and hollering and writhing around on the ground. An older man was having problems breathing. Others were in shock, asking us if they were going to die. There were fourteen injured people we could see. It was hard to get an accurate number because we would just think we had seen them all then realize a patient was over there yet, then find out it was one we had already seen and counted, they had just been moved. We finally had everyone loaded and took them to the clinic to try and evaluate which ones we could treat and which would have to go down. Thankfully our ambulance is an old army ambulance and so has room for four stretchers. We chose the four most serious looking cases and loaded them up with some family members and the ambulance headed down. Needless to say, it was a pretty full vehicle! We worked until a little after one o'clock in the morning on getting wounds dressed, pain meds given, etc... Of course the man who was drunk couldn't pee... Anyway, it was a long night of work and a short night of sleep. Only the one lady died on the scene. Now we have heard that the lady with a broken neck died also. It was bad... But could have been so much worse...
   We are truly in the time of no rain. It is supposed to be rainy season here and it hasn't rained for several weeks. One day we got a few sprinkles but not enough to water the crops. They are going to suffer if it doesn't rain soon. The locals say they never remember a July that was this hot, dry and dusty. I haven't met many Haitians with allergy problems but my nose seems to run very well.
   The other week a truck pulled up in front of the clinic and an unconscious man was carried in. He had high blood pressure but nobody knew what had happened to him. Supposedly he had been found unconscious in his bed. His family readily admits that this man drinks a lot and doesn't eat well at all. The family says they are all Christians except this man. The only conclusion we can come to is that he drank too much and almost died. We give him several liters of IVF's and try to get his blood pressure down but aren't successful. Then the truth comes out that this man is a witch doctor. Wow! It gave me a very strange feeling to know I was treating a witch doctor, whether he was conscious or not... We sent him down to a hospital in Port-au-Prince because we couldn't get his blood pressure low enough to feel comfortable sending him home. He never regained consciousness while at the clinic. I don't know if he did at the hospital or not. We don't know, he may have had a stroke from the high blood pressure. Now we have heard that he died.

Some kids put beans in the most in opportune places...

  This week has been very full of adventures. There was a three year old who came to the clinic because she had a bean stuck in her nose. She had put it there the night before so it had had all night to swell with nasal ... Snot... So it was quite large by now. At first the mom said it was a rock. Then it started to come out in pieces and we discovered it was a bean because on one of the many attempts it took to retrieve the whole bean I got "bean skin". We had the child on the table and the mom and Mirlene were holding her body and legs. I guess you could say I had her head in a head lock... And that bean was lodged securely! I think we did get it all though.
   Then there is a little boy that we have been following for malnutrition and ear infections for several months. Finally on Monday I wrote a referral letter and told the mom she had to take him to the hospital. I think we finally got the ear infections under control but he still wasn't gaining weight.  We have been giving the mom protein powder and some milk powder that is almost like pediasure and he LOVES it. I wonder if he has a digestion problem. Hopefully they will find out at the hospital and he will do okay.
    Next is a 14 year old girl who is short but has a large stomach and weighs less than 50 pounds. She has had an operation on her abdomen in the past. Mom said they removed a "ball" so we don't know really what it was. She is also a diabetic and her insulin was gone. We don't have any insulin at our clinic. There is not a good way to store it over here since it needs refrigeration and so few people have that available. She eats lots of food but it looks like her body is literally in starvation mode because she can't break down the sugar properly. We did give her some of the oral hyperglycemia medications we have to see if they will help. The mom has nine children and no one to help her so feels she can't take this child back to the hospital right now. We are hoping to get this child some help somehow.
    Then there is a little girl who has a massive belly and is also malnourished. We seriously considered taking her to the hospital in our ambulance but decided to give them one more night. I gave this child lasik and an enema plus de-wormer and an antibiotic then sent her home with some laxatives to take that day yet. This mom did have a working telephone so we took her number and called and checked on the little girl that evening and the next morning. They were supposed to return to the clinic on Wednesday but when we called the mom she said the child was having so much diarrhea that she couldn't bring her. So we told them to come today and even called the mom and talked with her this morning and they said they were coming but never showed up. We aren't sure but suspect we will have to send this child to the hospital too if we can ever get her to the clinic again.
   On Sunday morning while we were in church somebody broke into our house. They chose to break a window that is above the back door and come in that way. The window is only about eight inches tall but as wide as the door but somehow someone got in then unlocked the door. Somebody got cut or hurt somehow because they left numerous smears and drops of blood around. They took some money, Keith's laptop, Candace's phone and a pair of her sandals. I guess they ( the sandals) were too good of a deal to pass up... We don't know who it was and don't know if we ever will. The laptop is the biggest thing, it had a lot of clinic info on it that wasn't backed up to a hard drive.
     Yesterday morning we had a five year old girl come in unconscious. She has cholera! We kept her on IVF's all day hoping the diarrhea would slow down but it didn't so finally about six o'clock Trevor and Zach took her down to Port to the hospital. I was occupied quite a bit with her and our Haitian nurse does pregnancy classes on Wednesdays and there were about 70 pregnant women at the clinic yesterday so we all had a long day. When we sent the child down she was on her sixth liter of IVF's and was not in fluid overload but rather still a bit dehydrated. We don't have a large supply of chux pads to begin with and were using them pretty fast so I finally put a tube in the little girls butt to collect the diarrhea because it was just like water, then attached the tube to a drainage bag. In two hours we had gotten 1600ml out! I didn't go down with the ambulance but before they left I told the mom, who would ride in back with the little girl, what all the tubes were for etc... Trevor checked on them when they were about half way down the mountain and they were ok but..... When they got to the hospital both the rectal tube and the IV were out and there was cholera diarrhea all over the back of the ambulance. When asked why they were out the mom said they were hurting her... So I don't know if she took them out or if she let the little girl do it herself. Never the less... Trevor and Zach had to get bleach from the hospital and clean up the back of the ambulance before they even came back up the mountain. I hope that little girl makes it because she was a pretty smart five yr old. Now we are hoping that there won't be a cholera outbreak...
   Then this morning a nine month old baby came in with retractions, a fever, and decreased consciousness. He was also dehydrated from vomiting and diarrhea. I couldn't find any veins on this child except one in his head so he had to have his IV there. I gave him numerous nebulizer treatments, steroids, and antibiotics and then we started working on getting everything set up for somebody to take him down to the hospital too. So the ambulance went down again today. It's really getting a work out this week, we just pray it won't break down on the road because it has had some difficulties lately.
   I'm tired...