2/8/10 - Team 3, Day 3

Oatmeal with brown sugar, orange wedges, tortillas with peanut butter, and a half cup of coffee started the day. Our team had a fresh head of steam, and as some of us walked down to the clinic, others drove the ambulance down the hill to pick up patients from the ward, to bring for surgery. EMT volunteers arrived later in the day, and took over the driving and transport responsibilities.

The clinic was scheduled to open at 7:30, so we arrived down there around 7:00 to get ready. The Haitians knew we had a full staff, and by then had already formed an impromptu line outside the clinic doors. They self-triaged the sickest among them, presenting them to us as we unlocked the large steel doors of our clinic, and we immediately admitted several patients with serious problems. As the Haitians lined up, eventually by the hundreds, they sang hymns together spontaneously, sitting in the hot sun, side by side on concrete walls and metal chairs, from the youngest children to the grey haired elders. Their spirit and toughness continue to amaze me.

One elderly lady turned out to be the mother of one of the MOH staff. She passed away this afternoon despite great efforts, and volunteers from the Oklahoma medical team helped the family transport her body to the family's home. In Haiti, families are required to remove deceased members and arrange for their burial. Despite the untold numbers of deaths here, every death we witness is accompanied with great mourning, large numbers of family and friends gathering, every lost life is great.

Today, one of our ward patients recovering from a very high above the knee amputation, who is also 6 months pregnant, was finally told by her family that her 3 year old daughter was killed in the earthquake. Mother and daughter were together inside a building when the earthquake hit, and were then separated, and when she was rescued she could not find her daughter. Her family chose to not tell her, and the medical staff here honored those wishes. The horrific sorrow she felt in this moment was difficult to bear.

Our first surgical case today was a trimalleolar fracture, and Dr. Laura performed an ORIF with plating and screws. The neurosurgeon from Oklahoma, Dr. Jeffery, scrubbed in and assisted expertly and this young patient will walk again, in time. By mid-morning, our "pre-op" area was filled with mattresses and stretchers, patients and families lining the walls between our procedure trays and block stations. Christina, our wound care therapist, worked tirelessly, all day long, on difficult wound debridements. I did ankle blocks as anesthesia, field blocks. One such patient was a young woman with multiple burns and wounds on her feet and back, rescued from the earthquake rubble. She did very well, and she has a very good chance of a full recovery. We did conscious sedation for others requiring difficult dressing and cast changes, and wound care. One patient required debridement of her infected below the knee amputation, and we cared for her in the OR under a spinal block. Dr. Laura was everywhere, triaging ortho trauma patients in the clinic and running back to the OR area to do the cases when we were ready for her. She has 2 year old twins and a 3 and a half year old. I asked her what drove her to come this week. She said simply that God had given her this gift of healing, and she intended to use it where it was needed the most. Wow, what an inspiration she is to all of us on this trip.

One other patient was brought in this afternoon in the back of a pick up, with what turned out to be bilateral acetabular fractures that she sustained during the earthquake who had not yet seen a doctor. We admitted her to the ward for pain control and fluids, and Dr. Laura thinks we will try to arrange for her to be transferred to a larger hospital in Port au Prince as soon as we can find one to accept her. We are not equipped here for that type of major surgery, but will care for her until she is transported.

We placed the first of our wound vacs today! We have been receiving requests from all over the countryside for wound vacs, as the word has gotten out the MOH has some. The rumor mill had us with "a dozen or more", in reality we have 4 with minimal sponges and back up supplies. This first one went to the young lady with the large wound on her low back, having been pinned for 5 days under her church rubble. The nuns and physician from the Mennonite mission who have been taking care of her, came with her to MOH, and all were so thankful and full of hope that we could help her. She needs more sponges, we hope to get some in with our replacement team on Saturday. With God's help, the wound vac, and close follow up, she can heal this wound.

We lost power in the OR and clinic twice today. The first time was in the middle of our first case, it was just a flicker of loss, but enough to shut down our autoclave and our fan. We were soaked head to toe with sweat by the end of the case, as was our young patient. Mitch and I fixed both the autoclave and the fan in time for our next operation. The power went off again just before sunset. It turns out the facilities here have two generators, one running the main guesthouse and staff quarters, and one running the clinic, orphanage and school, which is now our hospital ward. Last week the second generator went out, leaving just the one main one, now tasked with running the entire facility. When it went down, we were just starting the BKA revision. We used headlights and flashlights to finish the case. She did very well and is on our ward tonight recovering. She has a very high below the knee amputation, and Dr. Laura is trying to save as much tibia as possible, because if we have to revise her above the knee, recovery is much more difficult and the prospect of functional rehabilitation with a prosthesis is lower.

Talking with Dr. Cheryl today, we learned that the unemployment rate here is 85%, that 90% of the population is under 18, and that 30% of the country's GDP comes from the Haitian "Diaspora" - relatives of Haitians now living in America and elsewhere, sending money and support to their Haitian families. There were many problems facing this country, politically and economically, as well as medically, before the earthquake, and of course now those problems are multiplied. The staff and volunteers at this place are amazing, it is an honor to work with them. Texas Ortho and HCBC arrived right after the earthquake and literally raised a fully functioning hospital out of the dust. God's hand is everywhere I look, and I pray now for strength and endurance to do as much as we can, with this opportunity to serve.

Robert Wills, MD
Austin Pain Associates