WhiteCoat

An ER Doc in Haiti: Day 3

EscombrosBelAir5

January 27: We’re seeing a stabilization, but what about follow-up?

We are right down town in Port-au-Prince today; pretty much every building around us is destroyed. The only thing still standing near us is a church, which is currently housing a local boy scout troop.

The effort is starting to see a logical transition right now. At the clinics you’ll get 10 to 20 people walking in with soft tissue injuries – big gaping wounds that are infected – but fewer and fewer people are needing amputations and surgery. I did get a call from a guy in an outlying area who needed a hand surgeon, which we arranged. Other than that, we’re seeing a stabilization. We’re running a clinic today and it’s a typical third-world situation. You announce that you’re available and everybody who has had a backache or a stomach ache for the last five years shows up. As soon as we arrived today, about 200 people queued up. They were very calm and controlled, lots of kids with dehydration and plenty of vague complaints. We’ve got eight treatment stations, 2 or 3 wound treatment stations, a diarrhea station, an upper respiratory station and then whatever else walks up. It’s typical emergency medicine, really. You have to sort through the masses to find the people who are really sick. Haitians can be hypochondriacs just like Americans. They never get to see doctors, so when one shows up who is free, everybody lines up. Generally speaking we’ll run into about a dozen seriously-injured people in a day, but we’ve got to sort through 400 people to find them. We’re going to another place this afternoon where there are supposed to be some very, very sick people.

ComfortUSNS Comfort on diversion?
I got my first look at the USNS Comfort, which is off shore a couple miles. We’re next to a landing zone where helicopters are flying in and out, but right now there is no one waiting to go out. The word going around is that the Comfort is basically full and they are now trying to figure out how to bring people back on shore. The army was talking about setting up a 250-bed post-op rehab facility for all of the people coming off of the comfort. They have some tremendous injuries out there, spinal cord injuries and ICU patients, that will really require follow-up care.  It’s going to create a problem on the backside. We’ve heard that the Obama administration has set a timetable for pulling forces out of Haiti – which makes sense – but there is going to be a lot of long-term care that they’ll need to plan for. There are a lot of sick and injured folks here.

Heavy on medical supplies, light on water
We’ve got medical supplies coming out our ears, but they told us when we left the camp this morning that we had no more water. They said they were going to go try to find water for us. I’ve got a bottle on my back and one in my pack, but that’s the end of my personal stores. I’m assuming we’ll find more – we’ve got a logistics expert tracking it down – but we’re getting a little hungry. I had nothing for breakfast and I have yet to eat my Powerbar for lunch. I’m hoping that I’ll get something for dinner.

Surgery Transfers
I’ve been taking patients who need surgery to Sacre Coeur (Sacred Heart), where they can receive treatment, since I know the doctors there. I put them in the back of a truck and take them there personally. When you walk into the hospital, you immediately hit an interior courtyard which is set up as a triage emergency area. It’s a big giant mess. A doctor sits out in the middle of the courtyard with hundreds of people around him, sorting through to find the ones that need to go in for surgery. I was able to bypass this, discuss the patient with the doctor, and take them straight inside. Yesterday I ordered my own X-rays, read them and handed them to the surgeon. It made for a very efficient system.

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