Emergency Medicine

We worked very hard to get heatstroke on Monday, our final day of clinical work in Haiti.

The taptap needed a repair, so we were unable to start out right away with mobile clinic. Instead we made a housecall that was needed. At the start of the earthquake, the medical aid response was huge. Doctors, nurses, surgeons, paramedics- rushed into Haiti providing life-saving care. Many operations were performed. A popular procedure was reduction of fractures and stablization with external fixators- large medical devices that keep the bone straight and in place on the outside of the body. The problem is that all of the surgeons left. Nobody is here to take out the external fixators. Now there are thousands in Haiti with devices in their bodies unable to move or walk, and getting secondary infections because of the permanent wounds. We are working hard with agencies right now to address this. The pediatric hospital, St. Damiens (which was a regular hospital comandeered by international pediatricians and neonatologists) has agreed to even see adult patients on a limited basis, and will remove the fixators when appropriate. We are responsible for maintaining care until then.

A lovely woman who has been kindly taken in to an actual house (one room) up the street from our clinic receives regular house calls from us for wound care on her external fixator. Things had been fine until Monday. On our visit on Monday, we found the wounds to be pussing, hot to the touch, and with other signs of infection. We immediately prepared the woman for transport. We could not find our only doses of our first choice of antibiotics, so were forced to compromise with an injection of an appropriate med, and oral follow up with a very less than ideal med. We wish we could tell you this was the first time we did this, but it is what it is in Haiti. We sent her immediately to the children's hospital.

While we were out, a large aftershock hit the church, and many ran out from the building. There was no damage, but many were scared. Eventually we were able to load up to the taptap. On our way down to the street we ran into many who had been scared out of the building- mostly amputees- who would go no further. They were unable to be seen by the others upstairs in the clinic, so we set up there and saw them all. Eventually we were able to finally hit the street, and again we set up in front of the Cathedral.

We saw many that day, and Bel Aire most certainly set us out in clinical style. These were the sickest patients we had seen during our entire stay in Haiti, and we were more like an emergency room than a clinic. We admitted or referred 6 in the last hour alone.

I saw a baby in the gutter that was being rocked by a teenager with a foot. He stated the baby was fine but we demanded he be brought into the truck. The baby was a double-orphan because of the quake, and had non-stop diarrhea for one month now. Not uncommon, the people drink any water they can find, and boiling is almost never an option.

Maryclaire saw a pregnant woman who has had vaginal bleeding since the earthquake. She would pass a handful of clots nearly every day.

I was called out of the taptap urgently because there was an older man, who could barely breathe, and could not stand or walk. When I found him in the filthy room, he was working hard to breathe and was in obvious pulmonary edema and heart failure. We did not have the medicine of choice, but a similar medicine was available to start to take the fluid out of his lungs. I brought it back but it is a blood-pressure lowering medicine and we had to check his pressure first. Of course it was extremely low. With my penlight I could now see the signs of extreme dehydration. He was dehydrated, yet his lungs and legs were filled with fluid. I rehydrated this man right there so I could take the fluid right out of his body again. I admitted him urgently to the General Hospital.

On the way to the taptap, I was expecting to tell the driver we were leaving immediately. A man ran up to me with a baby wrapped in a towel. I looked at a light bandage over the neck, and found a gaping wound. We examined the baby on the taptap. Two month old with signs of extreme sepsis. We aadmitted the baby to MSF (Doctors Without Borders) as the child had already been turned away elsewhere.

The afternoon continued to be a challenge. It was hot. We were dehydrated and could barely stand by the middle of the day. It would take all night to put the fluids back into us, and earlier both Maryclaire and I had to be rehydrated in the clinic (image to the right is crusted salt on my shirt at the end of the day. The streets of Bel Aire certainly did not hold back on our last day of work.

-Aaron