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Friday, February 12, 2010

2/11/10 - Team 3, Day 6

If you want to be seen at the Mission of Hope clinic as a patient, you first have to get to the front gate. Before sunrise every morning patients and families mass up at the gate, and a pre –determined number are allowed in to come up to the clinic. Dr. Cheryl determines this volume daily based on the number of doctors available to work. Today, the gates opened a bit later and I had a chance to walk down to the orphanage. Ms. Rachel runs the orphanage, and is full of love and toughness. She let me sit with her while she gathered the kids in a group to make an announcement and give work assignments.

Dotting the rock and chicken scratched open yard between the school and the kids’ dorms now sits about 30 high quality dome shaped tents. These are the boys’ quarters since about two weeks after the earthquake. At that point one dorm was found sound, and the girls were moved in. Today is a big day, because, as Ms. Rachel explains in demonstrative Creole, the other dorm has been declared safe and we are taking down all the tents, and the boys are moving back inside. God is great.

As I made my way back toward the clinic, cutting around hanging wind dried clothes and groups of playing and working kids, Ms Rachel asked me to walk a sweet 8 year old girl up to the clinic to look at a hot soup spill burn on her back. Christine was in clinic and helped me clean and dress the burn, 2nd degree with blistering but not serious, and I walked her to the open door of the clinic, all the nurses and I gave her fist bumps and off she went. Bright white smile turning towards the orphanage.

Dr. Cheryl arranged for us to go into Port au Prince today. We are transporting our GSW paralysis patient, and assessing General Hospital, and trying to gain perspective on the extent of the human tragedy occurring in Haiti. Traffic was very heavy, bumper to bumper and side to side, trucks, cars, bikes, motorcycles, UN vehicles, US Army convoys, US soldiers in combat gear all crisscrossing in controlled chaos. I’m still processing all that we saw, but it might be indescribable, in terms of the utter devastation of the buildings and homes, the smells and stench and packed shanty town blocks tumbled up on each other, construction debris and garbage mounds two stories high closing in stagnant water concrete drainage canals. Everywhere people. We passed through an area outside of PAP controlled by gangs, and saw gun barrels sticking out concrete openings guarding territory. Street vendors head carrying corner-prepared food and produce circled everywhere.

We turned a corner, went through a large swinging gate guarded by three US Army soldiers, and we were “inside” General Hospital. The hospital is outside. It is a series of tents crossing three streets, some set up as medical, some orthopedics, OB-GYN, lab, trauma, on and on. We saw the nursing student building with the collapsed second floor, where 200 students sat taking a nursing exam, 100% mortality, all were killed. Tired doctors and nurses, medical staff, others, very large scope, they are doing hard work.

On the way back up to MOH, we saw a whole other part of Haiti. In better years known as the jewel of the Caribbean, we stopped at a place for a team meal that proved it. Wahoo Bay (see is a beautiful little resort, Dr. Cheryl knows the place and staff and set it up for us to stop and eat. Blooming bougainvilleas, brisk ocean breezes and good Creole cooking were an almost eerie contrast to the rest of our week. The resort was empty - no guests - and the many empty rooms seemed ironic in the face of the reality two hours drive down the main highway. We had invited the Canadian team to come with us, and we prayed and dined together.

Just before we left for Port au Prince earlier in the day, we admitted a 9 year old girl with fever and buttock swelling. When we got back from dinner, we stopped to do ward rounds, and she was very sick. Tachypneic, tachycardic, she was really struggling to breath. Her buttock swelling was tense, symmetric, and now had spread up to her midback and chest, and down to her thighs, front and back. All of this pointed towards a diagnosis of necrotizing fasciitis. Knowing that in our OR we could not control her airway, had no oxygen, and no advanced pressure monitoring, and no way to handle her post op wounds, we determined to try to get her transported to another facility. We alerted Dr. Cheryl, and made arrangements, and at about 1:45 AM finally pulled up to the University of Miami hospital. We were back in Port au Prince. This place was phenomenal. Set up in a large military style tent, it was overall about the size of a high school gym, fully air conditioned, divided about in half by hanging burlap sheets dividing the hospital ward from the “sterile” OR and ICU side. We rolled our scared, exhausted, patient back to the ICU and turned her over to a team of pediatric surgeons, trauma surgeons, EM docs and advanced staff of all kinds. They had a fluoroscopy unit, multiple ultrasound units, 5 anesthesia machines, advanced monitoring devices. A field-trached Haitian patient lay just inside the burlap divider, on 5 drips and monitors, dying. Before we left, the medical team had determined to try to get our patient air-flighted by the US Navy out to the USS Comfort. We hope to follow up, to see if she survived.

We finally arrived back at MOH around 3:15 AM, and my tent and sleeping bag welcomed me like a 5 star resort.

God Bless,
Robert Wills, MD
Austin Pain Associates

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