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...