Today I saw an 18 month old little girl with a colostomy. It is the first colostomy I have ever seen here in Haiti. The mom said her surgery was 3 months ago. She had run out of colostomy bags, etc... I don't know how long ago, so she had just been putting another diaper on backwards. The skin was red and irritated but I have seen some colostomies with more skin breakdown in the U.S. I remembered seeing a box on the top shelf in the pharmacy that was labeled "colostomy supplies" so I went to check out what we had. There were several bags that would work for someone her size so I put one on and then gave her a couple extra to take home with her. Who knows how long those supplies will last, possibly only a few days if she can't get a good seal but it is better than nothing. The mom said they have a follow-up appointment at the hospital in November. Hopefully the colostomy is only short term and she will be able to have it taken down soon. One kind of cool thing- while I was working with this patient Roseline came into my room to ask a question and said she had studied about colostomies but had never seen one. Now she has...

     Another patient I saw several days ago had an injury on his lower leg. He came hopping up to the clinic using two sticks to help him balance and a lady was walking right in front of him holding his injured leg/ foot up off the ground. I don't know how far they came walking like that. Supposedly he got kicked by a horse three days ago. His leg was swollen and had large areas that looked almost like blisters with serous fluid underneath. I opened a couple of them and let them drain but did not treat his leg. I told him he had to go down and get an x-ray because it was possible that his leg was broken but I couldn't tell without an x-ray. He seemed very willing to go so I just gave him some Ibuprofen and wrapped his leg up so hopefully it wouldn't get more infected. He didn't really want any kind of a dressing on it. We were wondering why- when he said that someone had "tied" his leg and put some kind of herbal dressing on it. Well, that obviously hadn't helped... but I told him it needed a dressing because it was actively draining and the dressing I put on would not be tight, at all. I just used some abd pads and kerlix. They left the same way they had come, him hopping along using two sticks, her walking slightly in front of him holding his leg up off the ground. I hope the had a moto waiting somewhere for them if they had very far to go... 

     We also have a little kid coming in every other day for dressing changes on a burn on his foot. Roseline saw him on Monday and he would'nt let her touch his foot so she gave some Ketamine and then cleaned and dressed it while he was asleep. I decided a long time ago that it is inhumane to really scrub or clean burns here. We just do not have strong enough pain medication. But I have had very good luck numerous times using silver cream on burns here. The cream kind of debrides the burn. The little boy came back today for his first dressing change. I decided to see what I could do without using Ketamine, I did not want him to be in terrible pain. He was scared but did very well, I didn't clean it at all. When I got the dressing off it looked very good so I simply used a couple of 4 x 4 gauze squares to get most of the old cream off then put more silver cream on non stick pads then held those in place with kerlix and then koflex. It worked well and only took a few minutes. 

     The past week or so it has been raining almost every afternoon so clinic days have been shorter than normal. Most days lately we are finished at about lunch time. Yesterday was my turn to cook and I was hungry for mexican food so I made chicken fajitas, refried beans, sopa, chips and salsa and some bars for dessert. It takes a whole lot more time though when you have to make your own tortillas and chips. It was worth it though. Amberly helped me out by frying all of the chips and Jay grilled the chicken.  Group effort...

      Today I had already locked up the clinic and was walking to the gate to leave when a moto pulls up. It was the little baby that was born a week ago! I was so happy to see them! The dad and the aunt who were here when she delivered had brought her back. She had lost a little bit of weight but I don't feel like it is too much. Now she weighs 1.49 kg. They say she is eating well. She has an extra digit on each hand. We had told the family that when she came back we would "tie off" the extra digits so I did that today. I just used some number 4 suture thread. She hated it when I pulled it tight to knot the thread! She looked good and had a strong cry. Seeing her absolutely made my day!

      I have seen numerous sad cases this week. The first one was a 50 year old woman who was carried into my exam room on Tuesday. It appears that she had had a stroke. She could not speak. The right side of her face and mouth was drooping and her right arm seemed to be rather stiff. Her blood pressure was 211/108. I decided to try and get her to take an oral dose of nifedipine for her blood pressure. She did open her mouth for me to put the medication in but she was unable to take a drink so I used a syringe to give her some water to swallow the pill. She couldn't do it, the water just ran out of the side of her mouth. We had quite a few patients still waiting so Jay offered to put in an IV and give her a dose of IV blood pressure medicine so that I could continue to see patients. He gave her a dose of hydralazine then just hung a bag of normal saline to keep the vein open in case we needed to give her more medication later on. Initially when she came in there were multiple family members at her side. We have a policy that only two family members or friends can be at the bedside at a time so hopefully we can still get to the patient, so they had decided to let her sister and her mother stay, the rest of the family was waiting outside. When we re-checked her blood pressure it was slightly lower but she was still out of it, she could not talk and had lost control of her bladder. I proceeded to see other patients. This lady's family had stepped out for a few minutes and my assistant had also. I was sitting at my desk with my back to the exam table doing consults on a lady and a couple of her children when they was a crash behind me.  No verbal noise at all, just a thud... as this lady hit the floor. She must have been trying to roll over or something and fell off of the table. Her IV stayed in but of course the tubing was stretched tight and she was bleeding from her forehead. I quickly slapped my bare hand to her forehead to try and control the bleeding. Roseline is in a room across the hall and she must have heard the racket because she asked what was going on over there in my room. I told her my patient had fallen off of the table and was bleeding from her head, and yes, I needed some help. Jay must have heard the commotion also from the office so he came to help too. Roseline grabbed some gauze and held pressure to the lady's forehead while I went to wash my hands and get some gloves on then we lifted her back onto the exam table. When I removed the gauze from her forehead she had a wound almost in the middle of her forehead from hitting the corner of the shelf on her way to the floor. It stopped bleeding pretty quickly so we just put several steri-strips over it. Then Jay talked to her family- he told them that we suspect she has had a stroke and do not know how much if any of her previous functions she will regain. She is conscious, but does not seem to comprehend anything that is going on, cannot speak, and cannot swallow. It also does not seem like it would be of any use to take her to a hospital at this point. The family seems to comprehend the situation and take her home.  I heard this morning when I got to the clinic that she died last night. Fifty years old- that is life here. Real, every day life. On a positive note, I didn't have to fill out an incident report for the fall...

     Yesterday a woman and her 11 year old daughter came for consultations. The woman looked sickly but not deathly ill like she needed to be in the hospital. I did the daughter's consult first. Rather vague symptoms- stomach ache, head ache, diarrhea for 6 days. I had written for several medications for her then I proceeded with the mom's consult. She too had vague symptoms- head ache, stomach ache, etc... then she said she has had diarrhea for a year. Caution lights go on in my brain- I need to test this lady for HIV.  We have rapid HIV and syphilis tests at the clinic so I test her... she is positive for HIV. My assistant and I talk about it a little and decide to test the 11 year old also.  We are almost out of syphilis tests and the Mom's test was negative so I just do the HIV test. She is positive also! We ask the mom if she has any other children. Yes, she has another daughter (18 yrs old) who is here but they weren't getting a consult for her. The mom goes to get her and I test her also. Her test is negative. Where did they get it from? Did they give it to each other? Did someone else give it to both of them? Surely this wasn't congenital, I don't think the mom would still be alive if she had had it 11 years and wasn't getting treatment. We do not have the medication to treat HIV at our clinic but we take down their names and phone number and will pass that information on to someone who has a clinic in Croix-des-Bouquet. This clinic will then get in contact with the patients and provide medications and follow up. It is sad... I wonder how the child got it...

     Another patient I had yesterday was a man with an enlarged prostate. We have numerous patients with prostate problems who cannot pee and so need a catheter. Some of them come every month for a catheter change, some don't come that often, some only come when the catheter isn't working and they are in intense pain. It has been very difficult getting a catheter in this patient in the past. A little over a month ago when we changed it last I was not happy with how it was draining. It did not flow well at all so I had flushed the catheter several times and gotten multiple clots out but it still was not draining well. I left the catheter in place because it was at least partially working and told him he had to go get this checked out at a hospital. So, yesterday he comes back in a lot of pain and with bloody urine in his catheter. His catheter looked suspiciously like the one I had placed a month ago so I asked him if he went down. No, he hadn't.  He didn't have the money. So I asked him what he wanted me to do, I had done my best last time and he needed more help than I could give. Well, he didn't go down because he didn't have the money, but now he is back at the clinic wanting his catheter changed. I tell him I will try. I tried, several times, several different sizes, with no success. I cannot get it past his enlarged prostate. I give him pain meds, and an antibiotic for a UTI because his urine was bloody. Roseline comes in to help me explain to him that we have done everything we can here at this clinic. He needs more help than we can provide. If he is unable to pee without a catheter he needs to go to the hospital and not come back to us...It makes me feel bad, but I have done everything I can. We give him a little bit of money before he leaves to help with the expenses of more testing etc... 

     Yesterday I also saw a man with a mass on his neck. It appears to be some kind of a cyst and not an infection. It has been there a long time and just slowly gets bigger. They say a nurse from our clinic has drained it before, it was not filled with pus, rather a yellow liquid. It was quite a large lump and was bothering him so I asked him if he wanted me to try to drain it again. Yes, he did. So I got out the lidocaine and numbed a spot on the side of the mass then stuck a needle in it, and aspirated 22 ml of dark yellow liquid. It was a rather satisfying feeling when he left with a normal looking neck that only had a bandaid on it. I don't know what kind of a cyst it is, the fluid may re-accumulate, but hopefully it won't, at least not for a while.

     Casey and Rebecca and their boys were planning on coming today to visit but several of their COVID tests were positive so they can't come. I'm disappointed,  but I'll get over it. 

Medical dilemmas

      A beautiful little girl was born at the clinic last night. The mother thought she was 34 weeks along, by ultrasound measurements the baby was 31 weeks. The mom came to the our house in labor just before 3 pm. She said her water broke at 8 am yesterday morning. When we checked her she was definitely dilated and was having some contractions. This was her 4th pregnancy. Now the question is, do we encourage her to go down to a hospital? Do we take her down in the ambulance? Will we find a hospital that will provide care for a preemie? Will the baby live? Only God knows. We decide to take this lady to the clinic and let her deliver there. The baby's heart rate is good, but we have no idea what will happen after the baby is born. Ethically it would not be right to send this lady home to deliver. At the clinic at least we have suction and oxygen if it is needed.  Jay goes to the clinic with her, while Brianna, Amberly and I go to the afternoon service and the girls stay at home with Chancela. We are glad the girls stayed home when we realize how far we have to walk. It is 3 miles one way. We stop in at the clinic on our way home. The first lady hasn't delivered yet but now there is another lady there who is in labor also. The second lady is quite a bit more dramatic about everything than the first one. It is her first baby. Also she has drank ginger tea, which supposedly is to help a laboring mother, but as far as we can tell it just gives them a whole lot of extra pain. It seems that if they have drank ginger tea they aren't in pain only during a contraction, instead they are in pain all the time. I check the second lady and she is not ready to deliver yet. She is dilated to a 7 and everything appears to be advancing normally so we explain this all to her family. Now it is just a matter of time, and she is not yet ready to push. They are satisfied that everything seems to be progressing as it should so they go home. By now the first lady is fully dilated but does not yet feel the urge to push, so we wait. After a couple of hours we start an IV and some Pitocin to try and help speed things along. The baby's head is right there but she still does not feel like she needs to push. After the IV is in, we go home in shifts for supper. A little before 11PM  I check her again. It seems we are ready to go. I encourage her to push with the next contraction. The dad senses that the time is getting close and he disappears out of the room quite rapidly. When she pushes the membranes are visible so we pull the cart with supplies over closer to the delivery table, glove up, and are ready for this baby.  After only pushing a couple of times, the baby is born. The sac is still totally intact around the baby's whole body and the placenta comes right after. I try to tear the sac open with my hands. I get through one layer but with everything wet and slippery I can't get through the second layer. Jay grabs a scissors from the cart and opens the sac. It isn't even 20 seconds later we hear the wonderful sound of this little baby crying. I suction out her mouth and nose and we place her on her mother's abdomen for a few minutes before we take her to weigh her and get her dressed. She weighs 1.57 kg. The dad comes over to look at the baby while we are doing this. Almost right away he notices that his little girl has an extra digit on each hand just like he does. ( That is a very common sight here. Normally it is on both hands and attached by a small piece of skin. Usually the small extra digit does not have any bones but sometimes has a fingernail. ) The dad requests right away that we cut the extra digit off. Jay and I talk about it and give them a randevous appointment for one week. If the baby is still doing well at that time we will tie suture thread around the extra digits so they will fall off. We get her dressed and give her to the female cousin who has been at Mom's side all afternoon.  We try to get the baby to breastfeed before leaving the clinic but she really is not interested. The family is from a long ways away so they will be spending night tonight with someone they know here in Oriani. They all three plus the newborn baby get on the moto and head off into the darkness. We walk home, very happy the baby is alive. I have no idea if she will continue to do well or if she was just born too early to survive without being in a hospital. 

     On Wednesday I saw a 23 month old with severe injuries. I am unsure exactly what happened to this child. He literally had a hole in his neck where it seems like he must have had a large abscess. His neck was continuing to drain some pus but the hole was a very disturbing site. Whenever he would turn his head you could see tendons and things moving around in his neck. He had another wound on the back of his left shoulder that looks like it also had been an abscess that was mostly drained. These wounds both looked like they needed to be packed but it would have been inhumane to pack that one on his neck without some kind of sedation. Plus, this child needed more help than we could give.  His lower back seemed to be swollen and red, but it also had a huge black blister on it. The skin was peeling around these sites and he was swollen, for sure from his abdomen on down. The swelling looked like he was also suffering from malnutrition but it could have been from his other problems, I don't know.  The story is that 2 weeks ago someone was trying to carry this child on their shoulders when he fell. They think he landed on his head. I think he may have landed on his back. I don't know how the boils/ abscesses got there. Probably all of his injuries were exacerbated by "tying". It is a common remedy for any type of pain. Tying is folklore and is supposed to keep pain from spreading to another part of the body. The problem is, often whatever is used to"tie" the wound is put on too tightly and can cause circulation problems etc... Sometimes also, plants or herbs are made into a paste and put on the wound before it is tied. This can lead to huge infections. I suspect that is what led to the abscesses on this child but I don't know for sure. I couldn't tell if the skin on his back was burned or bruised or what exactly was going on there but I suspect an injury inside also, possibly a fracture or sprain of some kind. This child needed x-rays, IV antibiotics, wound care, etc... I didn't want to start treating him when he needed more than I had available.  For instance, I could have given him antibiotics. I could have given him a shot and oral antibiotics but I didn't.  I was afraid if I gave some medicine the family might not take him to the hospital right away, they might try to give the antibiotics for a few days at home to see if he got better but I wanted him to go to the hospital that day. So I simply gave him a dose of tylenol, plus a second dose of tylenol to take in a couple of hours and put small bandages on his wounds to hopefully keep the dust etc... out of them on the ride down to the hospital. I told the family several times they needed to go down that day, not even to wait until the next day. I'm afraid it was too late for this child already. 

 

Ti kay (little house)

       The ti kay is a little house right next door to the clinic. It is a small, one room house, furnished with 2 cots where patients may sleep if they need to be observed overnight. For instance, when a patient needs to be on oxygen- we can run the generator so there is power for the oxygen concentrator. This way we can lock up the clinic when we are finished for the day and still provide a room for patients who need to be monitored a little longer. On Friday I saw a 6 year old little girl- afebrile but heart rate of about 150-160, respiratory rate of 60, wheezing, coarse lung sounds, and oxygen sats of ... 50%. I never would have guessed her sats were that low just by looking at her. Yes, she was breathing fast but no nasal flaring, grunting, etc... We put her on oxygen, 5LPM is the max flow rate our oxygen concentrators can provide, so we put her on 5 liters. This only brought her O2 sats up to 88%- 90%. I gave several nebulizer treatments, a shot of Rocephin, Amoxicillin,  Prednisone,  and Tylenol.  A couple of hours later we were finished for the day but she was no better so we took her and her mother to ti kay. She did not look good so we told her family that we could watch her overnight, on oxygen, but if she didn't look any better in the morning she would need to go down to a hospital. Early in the evening I went to check on her then later on Jay would check on her again when he went to make sure the generator was running so she could get oxygen all night. She did not look any better.  She hadn't eaten or drank anything either. I told the family she had to drink something. If she didn't want to eat that night she would be fine but she had to drink. I also told them to give her evening medication. After that visit I was pretty sure we would need to find her and her family a ride down to the hospital the next morning. When Jay went later on in the evening her Dad had gotten there too. He explained again that we could keep her on oxygen overnight but if she didn't look better in the morning she would need to go to the hospital. The Dad  said they just did not have the money to take her down to the hospital, they were trusting God would heal her. Saturday morning I stopped in there before going to Foret market.  Her O2 sats were 93% and she had eaten a little and they had given her morning meds. The family thought she looked better, Dad wanted to know if they could go home.  So I explained to them that she was a little better than yesterday, but she was still on 5 liters of oxygen. She needed to have O2 sats of >90% without oxygen before she was ready to go home. Jay stopped in later on in the morning and thought she looked a little better to. Early Saturday evening I went to check on her again. She looked better, O2 sats about 93%- 94% so I turned her down to 4 LPM. When I was almost ready to leave the mom asked me if I could check the child she was holding who was asleep, he was sick also. He is her little brother, about 14 months old, and it looked like he had the same thing she did, just not as bad yet. It didn't seem like he had a fever but he was sweating because he was wrapped up in so many layers of blankets. His respiratory rate was 68 and his heart rate was 175. I told Mom we needed to take him to the clinic, I needed an accurate weight to determine his medication dosages. So we walked over to the clinic with him. It wasn't easy to get an accurate O2 sat because he was crying and scared but I finally saw 86%. I gave him a shot of Rocephin also, plus Amoxicillin, Prednisone,  and Tylenol. That combination of medications seemed to have helped his sister so I wanted to give him the same thing. We have some rapid COVID tests at the clinic so I did one on the little boy. It was negative. Then back to ti kay. I asked the mom if she had other children. Yes, she had 5 children- and I asked her if they were all sick like this- she said she didn't know because the others weren't here, they were at home. I told the family the little boy needed to spend night here in the ti kay also so we could check his oxygen levels too. Currently he didn't need oxygen but it looked like he had the same illness as his sister had. So they spent Saturday night in ti kay also. Sunday morning before church Jay went to check on them. Both children looked good, respiratory rate was still elevated, but not as much as the day before. The little girl's sats were 92%- 95%, the little boy's sats were 93%. He gave the girl a neb treatment then turned her oxygen down to 1 LPM. After 10 minutes she still had sats of 93% so he left the oxygen at 1LPM. I checked them around 1 o'clock in the afternoon. On room air the little girl had sats of 89%- 90% so I gave them my blessing to go home. They were instructed to come back to the clinic Monday morning so we could check their oxygen levels again. On Monday they both had O2 sats in the mid 90's. God really did heal her... he healed them both.

 I removed the stitches today and this is what his eye looks like. There is a small place on both sides of the eye that will hopefully continue to heal but the stitches were no longer needed.  One of these is at the inner canthus of his eye, it almost looks like a small piece of skin is missing. I am hoping this will conti ue to close with time. He doesn't seem to  have any problems opening or closing his eye though. 

A lizard in church

      I don't know how I forgot about the lizard that was in church during the funeral on Sunday but it slipped my mind the other day when I was writing. The lizard can't be left out though... It was only a small lizard, probably 3 inches long. One of the deacons who was sitting in front of the church was suddenly trying to get something off of his suit coat sleeve. This small lizard was flung onto the floor- not much later someone got up and flicked this lizard off of the pant leg of the man who was speaking. After his second descent to the floor the lizard crawled off toward the benches of men amd he wasn't seen again. I really wonder if he had decided to crawl toward the benches of women what would have happened... I don't know if a Haitian woman would squeal if they were surprised by a lizard or not. I wonder...

     Yesterday at the clinic I saw a woman whose complaint was that there was something in her stomach that hurt. It looked like she would be past child bearing age but she isn't sure how old she really is. I had her get up on the exam table so we could take a look. She definitely has some kind of abdominal mass, or more than one.  It seemed like there were 3 different masses, possibly connected but we couldn't tell for sure. She said the mass had been there " a long time" but I never did understand if that meant weeks or months. Jay was there at the clinic so I asked him if he wanted to do an ultrasound- yes, for interests sake- only the lady needed to understand that she needed to go down to a hospital for further testing. We would not be able to identify exactly what this mass was. Out of curiosity he measured the largest mass- 10cm x 7cm! We told the lady multiple times that this mass was not normal and she needed to get further testing done and suggested which hospital she should try to go to. Hopefully she will go soon, and hopefully it isn't too late for treatment. 

     Today I saw a little 5 year old boy who had a very bad case of infected scabies. He had sores that were filled with pus and mutiple places where the sores were open and bleeding. He needs to be treated for the scabies but before we can do that we need to get rid of the open wounds and the infection. I gave him Bactrim for the infection,  calamine lotion for his itchy skin, Tylenol, etc... and a tube of permetherin cream to treat the scabies after his sores are healed. Hopefully he will feel better in a day or two.

     Another patient I saw today was 19 years old. He came in with a scarf wrapped around his neck. He has a huge abscess on his cheek and neck, probably from an infected tooth. He said he had had this for  "a long time" also. It was obvious it had been a while because the abscess had started to open on it's own, way down under his jaw bone there was an opening that was oozing pus. I drained a little bit of nasty fluid but most of the area around it was very firm, not like an abscess that is ready to be drained so I gave him antibiotics for a week amd told him to come back for us to look at it again when the antibiotics are finished.

"Do you have a gift for me?"

      This is a question we get asked over and over and over again. It can vary slightly- do you have a little gift for me? Do you have a toy for me? Do you have something for me? Do you have something for me in your bag? Will you give me a dollar? Can I have a little gift of money? What do you have in your bag? It does not matter what age you are, grown people ask as much as the children. I guess there is no harm in asking... the white person only has two choices- give a little gift or say no. It gets old saying no time after time but if I give a little something today, tomorrow the same person will ask again and they will probably have a friend with them who wants a little something too. The other day Amberly and I had taken a walk up past the Digicel tower to the edge of the pine forest. Along that road it seems we gets asked for a gift even more than other places. We were on the way back home and were talking about how many times we are asked for something. I decided that the next person who asked us for a gift- I would turn the question back around and ask them if they had a gift for me. It wasn't long and we passed by a roadside stand. The grown woman there asked if I had a gift for her... so here goes. I asked her if she had a gift for me. no, she said she didn't but she was grinning so I told her everyone asks for a gift so I decided I was going to start asking too. She thought it was tremendously funny that a white person had asked her for a gift and was still laughing heartily when we walked on. So, I didn't get a gift but I bet I made that ladies day and Amberly really enjoyed observing the woman's reaction. 

     The man who needed stitches around his eye has come back once and is due to come back again tomorrow. I was very pleased with how his eye looked. I did take out two stitches because they seemed to be pulling a little bit too tightly. I will try to get another picture to post when he comes to the clinic again.

     Yesterday there was a funeral here. The man was from here in Oriani but he has been down in the hospital for a while. He had a lot of money and several businesses. The funeral was 3 1/2 hours long and involved much weeping and wailing. Even before the service had started they had to carry someone out- she had lost her shoes somewhere along the way so was carried out fish net stocking feet first. There were several hundred people in the church- all of the benches and chairs were filled and then there were people standing along both walls and down the middle isle. There are two steps all the way across the front of the church- there were 28 people sitting on those two long steps alone. Then there were a lot of people outside the church also. It was an entertaining service. The preacher had been talking for a while but was not finished with his sermon when the people decided it had been long enough - and decided to agree with and complete the sermon with an "Amen". That in itself is not unusual here. If you agree with what has been spoken you say "Amen" but the crowd would not be quiet so after several minutes the preacher just finished his thought and sat down. He told someone later that he wasn't finished with everything he wanted to say though. There was no church in the evening- the morning service had been long enough.

More later...

Don't drive drunk!!!

 Yesterday evening after dark an emergency came to the gate. Jay went to Port-au-Prince yesterday to pick up medications and he wasn't back yet so I went to see what was going on. At first I couldn't see much, just a bloody eye and face. I got some gauze and water to wash some of the blood off  so I could see what kind of an injury we were dealing with. This evaluation was done on the front porch which only has one light so I had the man who had come with the patient hold my phone with the flashlight on so I could see better. This guy's lower eyelid was ripped- on both sides of his eye. It looked like the eyeball itself wasn't injured but the eyelid was badly torn in several places. I sent a couple of pictures of the injury to Jay, hoping he was somewhere on the road where he had service so he could give me a second opinion. Initially I did not think I could fix this and would need to send this man down to a hospital but the more I looked at it I thought maybe I could try but I needed him at the clinic so I had better light and he could lie down. I gave him a shot for pain then called Jay. He hadn't gotten the pictures yet but he had cell service so I tried to explain the injury to him. He thought also that if the eyeball itself wasn't injured we could try to stitch it up. So I sent the patient to the clinic and went to get my shoes, a jacket, clinic keys, etc... the moto driver was waiting to take me on the moto also but Chancela was going to come help me so he went ahead and we walked. At the clinic, there were no lights. Nothing, at all! Not even a porch light. I was unable to get Jay on the phone now, he was obviously driving through a place where there was no service. Using my flashlight and a headlamp flashlight, I found a breaker box but all of the switches were turned on. I called Brianna to see if she had any ideas. She called Quentin for me and in a few minutes he was there. Meanwhile Chancela had gotten the guy onto the exam table and was starting to clean off more blood with the light from her headlamp. I don't know what Quentin had to do but he had the lights on in a few minutes so we could begin for real. We used lidocaine to numb it as much as we could. I used the needle to touch the skin there by his eye to see if it was numb. The guy wouldn't even answer me. He was quite drunk! In this case, I believe it was very much of a blessing that he wasn't totally with it. It had to be a very painful procedure even with lidocaine.                

Side note- do not try to drive moto when you are drunk!!! I have no idea how this injury even happened... I will put before and after pictures at the end of this post.

There were a couple of times during the stitching where the guy roused enough that he wanted to put his hands up to his face or he tried to slide down on the table but Chancela sternly told him to put his hands down and scoot back up on the exam table! We did have to help him put his hands down several times then try to readjust the drape we had over his chest. The skin came together well on both sides of the eye then we had some stitching to do on his forehead and a place on his upper lip. Jay arrived in time to put a few stitches in his hand while we were finishing up with his face. We gave him antibiotics, pain meds, and some antibiotic eye drops and sent him on his way. He is supposed to come to clinic tomorrow for us to check the wound. Hopefully he will come.

Just a warning... these pictures are kinda nasty!