Not much news today...

    The little girl who had burns on her back etc... Hasn't been back. She came three times and I was happy with how it was looking. I don't know if the family just decided it was getting better so they didn't need to come any more or what.
      On Sunday morning we had another long church service with 28 baptisms. This one lasted a little over four hours. We were very ready for lunch by the time it was all finished. During one of the baptismal prayers a "crazy" lady came in the church and marched right up front then pulled her bag of cheese puffs out of the back of her pants and deliberately started eating them. Then she wanted to put some money in the collection basket. I was sitting by the aisle so got a prime view of what all things happened during that prayer. It was rather humorous to say the least. She gave up on finding the collection basket finally then threw down her chip bag and walked out, leaving a trail of the remains of her chips on the way.
    One interesting thing, last Thursday in the night there was another kamyon accident. It was the same driver as tipped the truck near here earlier. Apparently he tipped his truck over the week before last too but nobody was hurt that time. This time sixteen people were hurt. It was further away from here but we went in case people would need transport to the hospital. He lost brakes going down a hill and all the people were thrown into a ravine. So far we haven't heard of any deaths from this time. By the time we actually got there another kamyon had loaded up everyone that was injured and they were already on their way to the hospital. It is a good thing too because it would have taken hours to clear the road enough for our ambulance to get by. We are all hoping this time the truck will be totaled  but don't know for sure yet. It looked bad that's for sure.  Of course the driver ran again. Seems kind of strange that he never gets hurt.
    This morning when we got to the clinic there was a lady there in labor. As soon as she came in the exam room we knew she had a bad infection because of the bad smell that came with her. She has four children already. We started IVF's and washed her up a little then gave some oxytocin. She did well until the baby's head was born but then his shoulders were stuck. We tried everything we could think of to help but his shoulders wouldn't budge. He had the cord around his neck too so when we realized the baby didn't really have a chance anymore we cut the cord then slipped it over his head. The cord had a greenish color. Finally after a lot of pushing and pulling the baby was born. He didn't have a heartbeat anymore though. We think if this mom had tried to have this baby at home they both would have died. I think the baby probably would have been pretty sick too because he had an awful lot of nasty green fluid coming out of his nose. The whole placenta was a greenish color too. This mom had been to our clinic the first of this month and had gotten antibiotics so we don't know if she didn't take them or didn't take the whole dose or what. We gave the mom IV antibiotics right away the wanted to watch her for a while before we sent her home. Turns out she was bleeding quite a bit and we finally got the family convinced that she needed to go to a hospital in Port. Meanwhile another lady was carried in on a bed. We couldn't figure out exactly what her problem was but we suspect tetanus. She had gotten a cut on her leg a month ago. We had stitched it and given her antibiotics but decided if the ambulance was taking one person down it might as well take two patients. They left right before lunch. One strange thing about these two pregnant ladies recently with terrible infections. They had both been to see some priest or pastor in he days before they had their babies. We don't know what all he gave them. This lady had been treated with "many bottles" though. I don't know what he could give that would affect the babies this way though because at the beginning of the labor both babies had a good heart rate. We hope this mom makes it.
  This weekend the orphanage girls are coming up for a short weekend. Then next week Craig, Lyndsey, Zoey and Amy come so I am very enthused!

And I thought I had a lot to write about last time...

    Friday afternoon we were supposed to have a members meeting at church to hear the converts tell their experiences then we would vote to see if they were all ready for baptism. Friday afternoon when the meeting was supposed to start it was raining. So we waited... When it quit raining about an hour later then we were going to have church so all of us from this household went. The ministers were still finishing up with a few visits so we sang... For an hour and a half... Then the ministers decided since not even half of the members were present we couldn't proceed with the meeting so we scheduled another meeting for Saturday afternoon. Saturday afternoon it was raining off and on so we went to church but once again not even half of the members were present... So we sat and talked, and talked, and talked... Until the decision was made that we would try one more time to have this meeting. This time we would have it after the Sunday morning service. So... To make a long story short... Sunday morning's service lasted from 9 am until 1:30 pm. There were 28 candidates who told their experiences and they were all approved for baptism. So this next Sunday will be another long service with 28 baptisms...
      For some reason I wasn't even present for half of the service Sunday. We had just finished Sunday school when a moto comes to the church with an injured man. This man got between a man and his wife when the man had a machete. Apparently the lady wanted to leave her husband and he was upset about that so was going after her with his machete. This other man stepped between them and got a whopping big wound to the side of his face and jaw. He lives a long ways away from here. He walked an hour up the mountain to get to someplace where they could get a moto. Then he had another hour ride to get here. When we got him to the clinic his blood pressure was 50/???. He was almost dead. Isaac and Heather had come up for the weekend so I was very glad for her help because Todd stayed at church. One of us held pressure to his face and the other one got two iv's started. When the fluids were dripping in as fast as possible we started to repair his face. He was cut from his ear to his lip.

Two places were through into his mouth. Several teeth had been knocked loose also. When we removed the clots we found some spurting blood so it hit an artery. We couldn't find two ends to sew together so had to sew it closed. It took several stitches but it worked. Then we could go about cleaning the wound a bit more and sewing it closed in two layers. We don't have blood products at our clinic so this man got 4 liters of IVF's. This brought his blood pressure up nicely. We used lidocaine where we stitched but that was the only anesthesia he got. I did have a couple of hydromorph pills that I gave him when we had finished stitching. He did amazing. We had just started stitching when this guys pregnant wife showed up. Someone had brought her on a moto. I think she was pretty much in shock about the whole thing too, probably not sure if she would find him alive. She watched the whole thing though and did well after we got her something to drink. I would really like to know what this guys hemoglobin and hematocrit was.  He had to have some stitches in his one arm too and some superglue to a cut on his thumb. After a short recovery time he headed home on a moto. He came back on Tuesday for dressing changes etc... And looked good. His blood pressure was good too. He is to return again on Friday.
    Sunday early evening a little girl and her dad show up at our door. This little girl somehow got burned. I don't know for sure how, the story seems rather sketchy. She has burns to her upper arm, shoulder and lower back and buttocks. They also come around close to her belly button etc... Pretty
much she has dressings all around her abdomen then part of one arm and part of one leg. Second degree at least.

One more strange thing, this child is three years old and she didn't make a sound while we dressed her burns. I didn't scrub them. I have found if I cover them with a thick layer of burn cream and dressings and change the dressings often that works as well as anything I've tried. Plus it is much less painful. She came again on Monday and Tuesday and got her dressings changed. Tuesday she did cry a little but it has to hurt terribly! She didn't come today so I sure hope she comes tomorrow. One thing the people here all have in their heads is that a burn should never be covered. They think it needs to be open to air. I do not agree with that. Even cold air hurts a burn and they need to be kept moist to heal properly. So that is always an education issue.

     Monday morning at 4:30 Keith got a call about a patient with cholera. Since I had had several cases on Sunday he called Githane to handle this one. I was very thankful. This was an adult man who had gotten cholera the night before at about 8pm and he was almost dead from dehydration. They got him IVF's etc... Were at the clinic with him for a couple of hours then came home for breakfast then we all headed back there again. We moved him and his bed outside so we could start normal clinic operations. Several hours later another family showed up with cholera too. So now we had four cholera patients plus the rest of our normal patients. We got them settled with IVF's if needed or lots of oral hydration then once again went back to our other patients. This family had lost two girls (a 8yr old and a 26yr old) on Friday from this same sickness but they still wouldn't believe that it was cholera. They said the other girls had something else then the "devil" got them. After numerous phone calls to the health agent where there is supposed to be a cholera center opening back up we got a health official of some kind to come visit the clinic and our patients then they told us where we could take these four patients. So late in the afternoon the ambulance headed down the mountain with them. Luckily since then we haven't seen more... Yet...

     There was a baby born at the clinic that day too. It wasn't too bad of a delivery, the mom just wasn't the most cooperative person I have ever seen. The baby was fine though. Hooray!
    Monday while I was home for lunch we had a storm. It rains here but that day there was thunder, lightning, and hail with the rain. The lightning hit the house too and messed up the inverter.
   Then today I had a grandma bring in her grandchild who was 17 months old, and weighed 5 1/2 pounds! It was terrible! I asked what she fed the baby and she said soup. I asked why she had waited so long and her reply was that the baby's mother is in Port-au-Prince and she kept phoning her to ask her what to do. I'm not sure what changed but she brought the baby in today. He has swollen feet and hands and eyelids from malnutrition. I hope it isn't too late for this little one.
     On Wednesdays Githane always has classes with the pregnant ladies so I see most of the rest of the patients. She usually sees 50-80 pregnant ladies on those days. Today while she was in class a lady came in in labor so I took her into my exam room. She had three children already and soon everything was set to go. This lady was very quiet and cooperative and after about two good pushes the baby was born. We surprised Githane by taking the newborn baby in her room to show the class. She hadn't even known there was anyone there in labor. Wow! That mother was amazing!
   Ok... Enough said for now...
P.S. I really enjoy reading those comments!

I was just reading over what I wrote the other day and decided there were a few more details I need to add. On Tuesday also the little boy with the prolapsed rectum came back in. He hadn't had any more problems until that morning when he prolapsed again. This poor little child knows he has to relax his body for us to get it back in and he tries hard, but it hurts so bad and your body's reflex is to continue to push. We finally gave him some water to drink to try and distract him. He was laying on the table on his stomach so couldn't really drink out of a cup so we were giving him water with a syringe. It wasn't long and he was refilling the syringe himself and having as good of a time as he could with all that was happening. When we finally got it back in this time he was squinching his butt cheeks together for all he was worth. He didn't want that problem again! We gave him some more Benadryl to help him relax and so far he hasn't been back. This day though his mom had brought his little brother to the clinic too for vaccines. We didn't want to risk another prolapse so mom took the baby home and then came back so she could carry him home too. Thankfully they don't live very far away. The little boy must have walked to the clinic that morning very painfully...
     Also, the little girl who we suspect had meningitis died the other day at the hospital. They did no further testing ( that is what we were afraid of) and I don't know if they kept giving her IV antibiotics or not.

 

We need an orthopedic surgeon...

   

 This little boy is about 18 months old and just came to see us yesterday. He has severe club feet. I told the mom she needs to buy him some 'hard' shoes and he needs to start wearing them on the wrong feet a couple of hours a day. She is supposed to return also with a phone number where we could possibly get a hold of her if we do find out an orthopedic surgeon is coming. He is trying to walk and the way his feet are now he stands on the outside part of the side of his foot and not on the sole of his foot at all. But I'm hoping if she will do what we ask her we can maybe help his feet to straighten a little because they weren't stiff in that position that was just how they bent without support.
     It has truly been a week of unusual maladies. Monday morning started with a 3 year old with cholera in my room and then an 11 year old who was mostly unresponsive and was having some seizures in Githane's room. So we didn't see any other patients for quite some time. The three year old was so out of it when I started her IV she didn't even flinch. Actually she was unconscious for a little while. She was VERY dehydrated and was having vomiting and diarrhea of course. We don't know for sure what the 11 year old has. The nearest we can guess is meningitis. She had a history of a bad headache a day or so before but when she came in she couldn't even talk. Her pupils were unresponsive to light and she didn't blink either. The problem is, there isn't an MRI scanner in Port-au-Prince that we know of, only a CT scanner and we do not think whatever she has would be revealed on a CT scan and we aren't convinced she would even get scanned. Her prognosis did not look good at all but she is still holding on and is definitely coming around. We are giving her IV antibiotics every twelve hours. She can possibly see some light but can't see much else but she can talk now and answer questions appropriately. So... We really have no idea how this one will turn out. We have tried to warn the family though that if she lives she may never return to how she was before this sickness.
 

Little cholera girl got IV fluids for several hours then was conscious enough she could start drinking too. She was able to go back home that afternoon. One interesting point about her- her mom said all the rest of her family wanted her to take the little girl to the witch doctor. They didn't want her  to bring the child to the 'hospital'. Actually her husband was so upset with her that he wouldn't even come with her. She was a very grateful mom, hopefully the rest of the family is too.
  Of course before we were finished with even those two patients a lady came who was in labor. It was her seventh child so didn't take long and wasn't a difficult delivery. That baby was an angry little thing though... And she had a big mouth and a fat face. It is so much less stressful though when the baby opens it's mouth and howls!

     Tuesday started about 6:00 with a lady in labor. First time mom, ready to deliver in the near future but not immediately. So Keith and I came back to the house for breakfast then went back and started the day in earnest. We thought there would be a baby born early but this lady refused to push so... The baby's heart rate was good so we just waited a while. Gave her some oxytocin too. Still she wouldn't push. To make a long story short, she had the baby about 11:00 and the baby was dead. The cord was around the baby's neck and I guess it had just been too long. It's very frustrating when I think of what would have happened in the U.S.  This lady's baby would have been monitored continuously and when the heart rate started to decrease or if anything funky was happening the lady would have just had a c-section. No questions asked. Here she is stuck with what we can do or else she has a three hour ride to a hospital. Discouraging, never the less.
    Also, the lady from last week who had a baby that died then came back in herself several days later ... We sent her down to Port, and the next day she died. I think she was septic. Depressing...
   Then on Tuesday right before we left for lunch a six year old boy came in with a prolapsed rectum. Todd helped me with that one. It took three or four of us to hold him down then some skillful maneuvering by Todd but we did get his problem solved, for the present. They stayed at the clinic until I returned from lunch and as everything was still in its normal position we sent them home. At 2:30 he was back with the same problem. This time it didn't take quite so long to return it to its normal anatomy but then we made him stay on his stomach for at least 30 minutes and gave him some Benadryl so he would relax. He fell asleep so we sent him home again. This time with more Benadryl for when this wore off and his mom carried him with one hand clenching his butt cheeks together. It looked rather humorous but it must have worked because he hasn't been back.
    We also had another little girl in with cholera yesterday but this one didn't need IVF's just oral rehydration and monitoring. This little girls' mom told Mirlene though that this child is always sick. She said if she can find anyone who will take her she will give her child away because she thinks the devil is tormenting her or something like that...
    By the way, I do enjoy comments on my blog. Makes it much more encouraging knowing someone is reading it...
   One more funny incident that happened to April and I last Saturday. We went to the market in Foret- des-Pins as we do almost every Saturday. It just happened that this time we didn't get home before the rain came. First thing, when we went to market we didn't see any moot drivers that we knew so just took a ride from the first person who offered. This guy didn't seem to be real experienced with driving but did okay. Probably part of his problem was that he just wanted to talk with us and seemed to really 'like' white girls. When we got to market he wanted to know if he could just wait for us so he could take us back too. We told him he really shouldn't because we didn't know how long we would be there... And we were thankful he took our word for it. So on the way home we were riding with one of the church brethren. We told him how the guy that morning really enjoyed taking us and he said that guy was "naughty" :) about half way home it started to rain... For real! I was glad I wasn't the one driving because the rain was coming down so hard and fast that it was hard to see. It didn't let up either. On the last hill coming into Orianie the water was several inches deep all the way across the road, not so easy to dodge potholes when they are not visible. Anyway, we were all laughing pretty hard by now. Going through the town people were huddled under their tarps or little pieces of plastic. We laughed and waved and kept on going. My phone has a very bad attitude when it gets wet so I was trying to clutch my bag closed under my arm for all I was worth. The hill just before our house is not a good hill to drive moto on when it is muddy. It turns into a mudslide. Sorel just put on the gas and away we went though

And then some babies are born with a tooth... But what about being born with TWO MOLARS??

  The other week a two month old baby came to the clinic for immunizations. This child was apparently born with two molars, at least they sure were bigger than any baby teeth I've ever seen! The teeth were loose though, like they should be when they are close to coming out. We didn't pull them though. We left them alone and hope the baby doesn't choke on them when they do come out!

  On Sunday there was another baby born at the clinic. This was this lady's first baby. She was in labor a long time so I'm sure she was exhausted, but the labor and delivery didn't turn out at all like we hoped. She had come to the clinic on Saturday too but wasn't close enough to delivery to keep her there. We thought surely she must have had the baby Saturday night in the night some time until we got a call late on Sunday afternoon that they wanted to bring her in again. So we headed to the clinic, started an IV and some fluids and gave her some oxytocin. This was about 5:00 in the evening on Sunday. Progress was slow, but there was some progress so we decided we would keep her a while to see if she could have the baby here before we attempted to take her down to a hospital. That always takes some time to get arranged anyway since we have to determine if the ambulance is running well enough to make the trip or if someone will have to take Keith's machine. Lately Keith's machine has had more issues than the ambulance though... Then we have to find a driver. Hopefully by then the patient's family will have come up with enough money to cover the cost of the gas for the trip. We had decided to give her some medications though and hope for a successful delivery here. About 7:00 we were thinking the baby would be born soon. Well, the baby's head was born and then things started going backwards. There were several family members in the next room watching. We had sent them to the other room when the time got close so we would have room to work. The mom was exhausted and the baby was stuck. We were trying everything we could to help this baby be born. All at once one of the family members comes hurrying in the room with some " witch doctor oil" that was supposed to give the mother strength. Problem was, it was very strong and Githane got a big whiff of it and she started coughing... And coughing... Until she was gagging and throwing up. Another family member was doing some sort of motions over the lady's belly. Trevor was at the clinic too but had no idea we were even having problems until he heard the commotion. None of us knew there was any kind of nasty smelling oil in their possession either.  Meanwhile the baby was still stuck and turning more and more purple. Mirlene started getting after the lady who had brought in the oil and she wasn't easy on her. It wasn't long and she left the room and that was the last we saw of her
that evening. Trevor said she tried to come in the room again but he wouldn't let her. She still smelled very strongly of "oil". We got the mom to change positions but still the baby was stuck. Finally we decided there wasn't any more hope for the baby so we would attempt to cut the cord to see if that would help at all. I had been able to feel that the cord was around the baby's neck but couldn't loosen it enough to slip it over the baby's head. It seemed like something loosened up when the cord was cut.  Several minutes later the baby was born followed by a huge gush of nasty, green, very foul smelling liquid. The baby didn't have a heart beat any more at that time. But then there was this awful smelling fluid to compete with the oil smell in the room. Then the placenta wouldn't come. Once again I had to stick my hand WAY up in there and help it loosen. It also had a greenish tinge to it. There hadn't been other obvious signs of infection until all this stuff came out. We sent her home with antibiotics instructing her that if she got a fever she needed to return right away. Well, today she came back with a fever, a high heart rate and her blood pressure was on the low side of normal so we sent her down. I'm afraid she has a massive infection.
   Now for a better story, Monday morning at about 7:00 another baby was born. This one took a couple of gasps of breath then yelled at the top of her lungs. That was beautiful! I had to laugh at her, she was mad at the world!