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Today we continue to see patients arriving from Port-Au-Prince with un- or under- treated orthopedic injuries and wounds. The number of people living on the compound continues to grow. We were awakened this morning at daybreak (around 0500) by the sounds of many families engaged in the morning routine. This, of course, included barking dogs, roosters announcing their presence, and crying babies.

Medical complex at Cange, Haiti

Photo by Samir Mehta

We are surrounded by life as well as suffering.

Pain Relief

We continue to be aggressive in providing analgesia for dressing changes when necessary. In addition to the anesthesia provided in the wards, we are starting to bring patients into the OR to take down dressings following skin grafts. Many of these folks have been experiencing 3 weeks of pain on top of the earthquake. They have simply had enough, and do not tolerate painful procedures anymore.

Having said that, more often than not we are met with a smile, and they thank us even when we return a fairly sedated child back to Mom's arms.

Moms here are very resilient. On our second day of surgery we later discovered that we operated on a mother's 2 children, 1 of whom is an infant, at the same time.

Just to be consistent, we sedated her children this morning, one after the other, to take their dressings down. The good news is that both children are doing well. Yea.

Helping Immobilized Patients

Girl walking with crutches

Photo by Michael Ashburn

Pulmonary embolus remains a common problem. It is difficult to get patients mobilized, and many have long bone fractures. SQ heparin is being administered when possible, but the limited availabity of nurses makes this difficult at times. We have no way to confirm the diagnosis of a PE other than to rule out infection as a cause if increased RR and hypoxemia. Treatment options include IV heparin via minidrip and nasal oxygen.

Yesterday a Haitian physical therapist arrived and went right to work. He has limited supplies, but is working hard to get people up and about. Many, many people will need prostetic care, and we have none.

In the meantime we are working on getting people up and about. This young lady [pictured at right] is a fast learner.

 

This report was written by Michael Ashburn, MD, MPH, MBA, during his participation in Haitian relief efforts through Penn Medicine in coordination with Partners in Health.

 

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