A few of the patients I have seen in the last week- a young girl, 18 years old, came in with a large wound on her foot. She looked rather sickly and it was obvious she had had that wound for a while. Both  of her feet and legs were swollen and both feet were peeling.  We have a rapid HIV test and a rapid syphilis test available so we decided to check her for that. We didn't tell her specifically what we were testing for but I think she knew that one of the tests was for HIV because when the man who had brought her stepped out of the room she asked if we would please only share the test results with her. Yes, that is no problem. She was obviously nervous that her test would be positive. Both tests were positive. We can treat the syphilis with IM Penicillin but the HIV positive patients we refer to the clinic in Croix-des-Bouquet. They provide medications and counseling for HIV and TB positive patients. I cleaned her foot as well as I could and then bandaged it. It was very painful for her so I did not get it as clean as I would have liked but it was better than when she came. We asked her to come back to the clinic for dressing changes but I don't know if she will be able to or not. She is from very far away. The IM Penicillin I wanted to give in a big muscle because it is painful so I gave it in her butt. Her whole back side was covered in thick, almost plaque-like skin. I hope we caught her illness soon enough that she has a fighting chance against it. 

     A young man who was in a moto accident and had a very large cut on his foot. He went to the clinic in Foret initially and they stitched it but when he came to us several days later it did not have any kind of a dressing on it at all and was very dirty. I cleaned it as best as I could, I removed some of the stitches as it was looking like it was infected. Todd and Donna are here visiting for a couple of weeks. They were here as missionaries several years ago and he is an RN so I asked for his opinion also on how to dress this foot wound. The wound really needed to be debrided but we do not have strong enough pain medication available to do that so we decided to do a wet to dry dressing for several days and see how it looked. I have changed his dressing about 5 times already. Twice I have needed to trim away some dead tissue. The second time I used lidocaine to help with the pain for that part of the procedure. Today we removed the rest of the stitches as they were no longer doing any good. It really isn't a job for anyone with a queasy stomach... it is rather smelly, but he has done very well with keeping the dressing mostly clean and dry. This one is just going to take time to heal. 

     A lady with a burn to her foot and leg that happened 13 months ago. It is unclear to me if the site has never totally healed or if it has opened back up. She also is from a long ways away so I don't know if she will be able to follow up appropriately. 

     A young lady today who was obviously in a lot of pain. She was in an accident about two weeks ago and had several bad copies of x-rays of her pelvis with her. The doctor had told her she didn't have any broken bones. We were unable to identify from the x-rays if there was a fracture or not, something didn't look quite right, but I don't know how to read x-rays either. For sure not ones as unclear as these were. Palpating along her spine did not cause pain, the pain was more on the side/front in her hip area. She is supposed to follow-up with the other doctor later this week but is in too much pain currently to make the trip down. I gave her some IM Tramadol, then Flexeril and Motrin pills to take and instructed her she needs to get to that follow-up appointment. 

     An elderly lady I saw today... her oxygen saturations were in the 30's initially. I didn't believe it at first, changed the pulse ox from one thickly calloused finger to another, to another. Listened to her lungs, diminished, but she didn't sound horrible. Called Todd and Jay in to look at her. The highest oxygen saturation I ever got on her on room air was 60%. Transferred her to another room where she could lie down and put her on some oxygen. We have a concentrator that allows us to give 5 liters per minute. On 5 liters, she averaged in the 70's, did get into the 80's a time or two for a very brief period. No coughing, just complaining of a headache and shortness of breath. I gave IM Rocephin, an albuterol neb (which did nothing at all- I just thought I might as well try it- it wouldn't hinder) then Levaquin and Prednisone by mouth. She stayed at the clinic all day on oxygen. We were at the clinic until after 4:00 this afternoon, by the time we were ready to leave she still was only maintaining oxygen sats in the 70's, still on 5 liters. So she is is the little house close by the clinic on oxygen overnight and Jay will take her down tomorrow morning when he goes to Port-au-Prince for medications. We do not have an accepting hospital , our best chance is to drop her and a family member off close by the hospital. If they walk up to the hospital hopefully they will be accepted and treated. If not, they will have to try and find a moto or some other transportation to another hospital. 

     And that is only 5 of the patients I have seen over the past week...

     On another note, the nurse who was planning to come here in October has backed out. So, if anyone is in the least bit interested in possibly giving some time here in Haiti please let us know. Or if you know of anyone who might be interested, pass the word around. I can almost promise you, you will never regret coming and giving some time to help others in need.