3/11/10 - Team 7, Day 5

Text from Glenn Speigler, MD:

It Is just so amazing that a group of strangers could become such a team. Each of us a piece of a puzzle. The whole far greater than the individuals. Have been doing 7 wk old cases with levels of complexity that until now I would have thought impossible.. To date no operative infections. We feel that in many cases the care is equal to the US. Another full OR today. Will be doing overflow on Saturday. Have begun scheduling for next weeks team. They will be operating. Have become the referral center for facilities much larger than us. Lives depend on future teams. Please please please keep them coming. With great appreciation and respect.


Update from James Dudley, MD:

Just as I hit 'send' last night, our team found out what it is like to have the only 24/7 hospital in this area of 'Ayiti'. An important security official from a nearby town showed up with several armed escorts at the compound's front gate, requesting entrance; he was suffering terribly from a "belly ache, belly ache, fever, terrible fever". The guards radioed up to the ward where Dave, the flight medic, and Amie, our nurse practitioner were on duty, passing on their request. They talked it over, (well, maybe for about 15 seconds!), and soon, they were evaluating the gentleman. The call came up to the Guest House a few minutes later; orders were given and treatments started, and in a few minutes, as the 'on-call' doctor, I was on my way down to the ward. At night, the local populations of ponies seem to graze more freely, closer to the roadside than during the day. But, they remain skittish. Even though I expect them to move away as I approach, when they finally do bolt, I can't help but feel my heart race. I couldn't help feeling a kid's sense of grand adventure, as I made my way down the hill. The stars to the south were spectacular with constellations we from the north rarely get to enjoy. I had asked Dave to place our newest charge away from the other patients, partly out of deference to his status in the community and partly out of concern that should he be contagious, it wouldn't compromise the other patients, most of whom are post-operative patients. The Mission of Hope Hospital has one of the cleanest Operating Rooms on this side of the country, and it has allowed our pair of Orthopedic Surgeons and our Plastic Surgeon to take on very complex, professionally satisfying, and meaningful work. They are giving significantly injured patients a wonderful chance to return to normal or near normal function, but it is essential that we be vigilant to prevent wound infections. Dave and Amie had come up with the perfect solution. The officer was appropriately placed at the far end of the ward's central hallway, away from the others, on a mattress with fresh linens. Along with the IV fluids and medications he had received, they had also done the hard work of reassuring him and his wife as well as his comrades. Our able, if sleepy, translator, along with the patient's high level of education and ability to give precise details about his illness made my job easy. We decided to allow him to rest in his relative privacy until one of our Haitian physician colleagues, Dr. Alix, could weigh in on the situation in the morning.

The waning crescent moon was just rising over the mountains as I made my way back toward the Guest House around 2 AM. However, another patient, a 5 year old trauma patient, came in around 5 AM. He was on a small motorcycle with his dad and another young man, headed to the clinic to have a rash on his hands evaluated when his bare foot slammed into a cinder block wall. A large cut on the inside of his ankle was just the tip of the iceberg. Again, Amie and Dave did all the right things. The IV Morphine eased his pain, and the first dose of IV antibiotics began infusing within an hour of his injury. They reported he never whimpered as the line was started. n the way down to check on him, as I rounded a curve and emerged from a clump of trees, I saw a small figure sitting on a boulder playing what looked like the guitar from a few nights earlier. Jean Marc, about 14-16 years old, sat facing east as the sun rose from behind the hills and lighted his face. There was no one within a hundred yards of him. Jean Marc is the daytime translator for us on the wards, and his shift hadn't yet started. We chatted as he strummed away and after a bit, I asked him if he sang or just played. "Oh, yes, I like to sing" and added his warm voice to the easy rhythm of the chords. he antibiotics were finished by the time I made it the ward. The boy with the injured ankle required not only orthopedic work, but the transfer of a nerve by Dr. Matt, our Plastic Surgeon. This nerve is to take the place of the nerve on the inside of the ankle that was avulsed by the wall. Without this nerve, sensation in the foot is lost, and in the harsh environment of Haiti, inevitably he would end up an amputee, probably after years of progressive disability.

The whole team is really coming together to make a difference here. As we share stories at day' s end, one concern we all have is who is going to step into our respective places once we leave. The need is not just now, it will be for years. Mission of Hope is working, as are many groups, to build this as a sustainable venture. This is the essence of the work we were all called to do when we set out on our careers. For any who are able, this is an opportunity of a lifetime.