A cut off finger-

     One morning last week a little boy, eight years old, shows up at the clinic before we had even opened for the day. I was there but was restocking medicines in the pharmacy. Jwa, the yard man, comes in and tells me we have a patient here with a "grav" injury. This little boy and one of his friends were playing with an ax. I don't know how it happened but the other boy accidently cut this boys first finger on his left hand completely off. There is a small piece of bone and some tissue above his knuckle but the majority of his finger is gone. It is bleeding a little but not as much as you would think. The boy seems to be in shock, he walked here with a neighbor because his dad is at work at a local bakery and his mom had already left for market. He isn't even crying. I cleaned it up a little then called Todd to come and help me fix it up. They didn't bring the other part of the finger so that solves the question about whether or not to try and reattach. Several months ago a man got his finger cut off and we sent him down to the hospital to get it repaired but they didn't do a very good job so we decided we would try to close this one ourselves. The other man also had some bone sticking out and we were hoping they would trim the bone then sew the end closed but they just put a couple of big stitches in to close it and it did not heal well. The eight year old did get some tears in his eyes when we did a digital block on his finger to numb it up but he held still like a pro. I think in the U.S. We would almost have to use anesthesia to do what we did. We cut a slit in the skin so I could try and pull the skin/tissue down while Todd trimmed off the bone. Problem was, we really didn't have anything that we knew would be able to cut the bone. The strongest thing we had available was a clipper used to remove ingrown toenails. We tried it but it wasn't big enough so Todd goes to his house quick and gets his wire cutter. We sterilize it the best we can and try again. This time it works. Todd got a little over a quarter of an inch of the bone cut off so now we can close the wound over the bone. We stitched it up, gave him a shot of Rocephin and some oral antibiotics and pain medicine and tell him to return the next day for a dressing change. He came back the next day and his finger looked good so we just changed the dressing. We were afraid it might get really infected because of the tools we had to use so gave him another shot of antibiotics the next day too. Now he has been coming back every other day for a dressing change and his finger is healing well.
     Several days after this a lady comes in and says that she miscarried twins the day before. She keeps using a phrase that Mirlene doesn't understand so we took her in to Githanes room to see if Githane understands. She says we need to check her because maybe the placenta is still inside the mom. We get her on the table and realize right away that we have a problem on our hands. The smell is terrible! Finally she admits that she didn't miscarry the day before but rather two or three days ago. And no, the placentas never came. I'm surprised this lady wasn't burning up with fever and sepsis already. After an IV and some oxytocin we realize this isn't enough so we proceed to do a manual d&c. It was terribly painful for the poor lady and I felt really mean but we know if we don't do this she could die. We got two placentas out but I wasn't quite convinced we had for sure gotten everything. Githane really thought we had though so we gave some IV antibiotics and oral antibiotics and sent her home. I really wanted to see her the next day too but she didn't come back so we don't know what happened. We didn't see these babies but the mom said it was a boy and a girl and that they were very small.
     Two days later a lady is carried in on a bed. She is having twins too! We knew she was carrying twins though. The little boy has been born and is bundled up in somebody's jacket. Does he ever holler when we expose him to the cold air while getting him dressed! Shortly after this a little girl is born. These twins too weigh about six pounds each. They are beautiful. We are sad though for the situation they are going home too. In this family there are three unmarried girls and all of their children living with the grandma. They are very poor. One of the girls has mental problems too. Several months ago we got the youngest child who was living there into an orphanage. She was very malnourished and I don't think would have lived much longer under those circumstances. Now she is doing well at the orphanage in Ganthier. I don't know how these babies got to be this big considering all the circumstances. I wish so badly it was easier to adopt these children! They deserve a chance...
     Keith's got back on Tuesday. Then on Thursday we all went down to Isaac's dad's funeral. It was the first funeral in have been to here in Haiti. It started at 7:30 am to beat the heat and lasted several hours. The church was full all the way to the back doors with standing room only, then there were people outside on both sides of the church and to the gate. It was pretty calm, only a few wails periodically. There was only one time the speaker had to call for silence.
    April flew back home on Friday for a week for her grandpas funeral so it seems quiet around here. Zach and Cam stayed in Canada for a while to work so Keith's just brought the three youngest children back.
    The time is flying by, soon I will be going home.