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Brilliant Starlight

I have been nothing but completely blown away by the clarity of the stars at night … They are brilliant – diamonds in the night sky.  And the moon rising over the horizon is like watching a sunrise – clear, crisp, bright.

Raucous Wakening to a Crowd

The mood here changed a bit today with a rather raucous wakening.  Around 5 AM, we realized there as a fair amount of “chatter” outside of our sleeping arrangements.  I tried to get in an extra hour before having to get up for “rounds” and take yet another bath with baby wipes (the unscented kind) since water did not start running until around 730 AM. As Babak, Derek, Mike, and I started to trek up to the Friendship House to meet Alysha, Babak informed me that there were “lots and lots” of people sleeping on the dirt outside the makeshift church (formerly known as clinic) right outside our window. This was rather weird since we had been here for over a week and this was the first time something like this was happening.

Maybe they knew that we had Prestige here.

Church Rounds

Still, it was rather odd, but we didn’t really think anything of it until we started rounding in the “Church”.  When we arrived in the “Church” it appeared to be even busier than it had been for the last several days – it seemed like there were more people, more families, and simply more … the smell in the air had changed.  There were definitely more people … and more new consults including a femur fracture in a young girl where the cast ended at her fracture, yet another open tibia, and a humeral shaft fracture – oh and the open metacarpal fracture that was over a day old (open) washed out, pinned, and closed in the ER.

Dr. Maxi informed us that Cange had grown in size by nearly 1500 people who had traveled all the way from PAP [Port-au-Prince] since there was nothing left for them there.  This explained the additional people walking around the medical campus, the number of “new” splints that I didn’t recognize or at least slightly remember … 1500 people also meant a lot of neglected or incompletely treated injuries …

Security Personnel

Derek Dombrowski with security personnel

Photo by Samir Mehta

As we walked to the SICU to see our patients there, I was taken back a bit by the black t-shirts that said “securite” … I thought they were a “joke” type shirt – you know, one you would pick up at the mall or on-line.  Nope – these were real security personnel – handcuffs and all.  Derek said “Why is that now that I see the security personnel, I fell less secure?” … To some degree, Derek was right – this was the first time we had visibly seen PIH security on campus.  This did not ease me at all either – particularly as the line in front of the ER was expanding.

Sudden Need for CPR

We rounded quickly in the SICU and walked into the MICU to find one of the patients (h/o heart failure) completely non-responsive.  There were multiple nurses standing around her doing a sternal rub.  PHT1 [Penn Haiti Team One] quickly jumped in – she was cold, had no pulses, and was not breathing on her own.  She had no board under her to start CPR so we moved her to the floor and I began chest compressions.  Babak and Mike took the lead.  I had not pushed on a chest (ie CPR) since my fellowship.  After about 15 or 20 minutes which seemed like an eternity, she was breathing on her own.  Still very unclear what happened. 

Lost in Translation?

Given the time, we decided we would complete rounds later in the day so that we could get the ORs going.  As I walked out, we did round in the “D” (dungeon) ward. Our patient from the day before who we washed out and was grossly purulent needed additional surgery and she was not happy about that at all. She had contacted her sister who lives in the States who then contacted her Congressperson to get her to the States for her treatment. It is unclear to me if she is understanding what we are saying. We have folks who speak Creole with us and her but I always wonder what is getting lost in the translation. Patients are getting frustrated having to go to the operating room multiple times – they want to be done (whatever done means) and move on whether it means a higher level amputation, a cast, a malreduction – “Just get me out of here and back to my home.”

Creating a Code Pack

The lady with the heart failure died later this morning after arresting for a second time. Amy and Erica decided to take two of our external fixator tackle boxes and make it into a code pack for when a patient codes.

Thinking About Heading Home

At the end of the day, we continue to try and figure out our return arrangements trying not to get caught up in the excitement of going home. We understand that inclement weather (snow) is on the docket for Saturday making an arrival that day more complicated.

The air is changing.  There are more people here.  They are frustrated.

 

This report was written by Samir Mehta, MD, during his participation in Haitian relief efforts through Penn Medicine in coordination with Partners in Health.

 

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