Viviane and Tyler both have connections to Haiti. Viviane is Haitian, born in Miami. Several of us had the treat today of meeting her 78 year old grandmother in clinic, she had arranged for her and others in her family to come up to MOH. Doubling as our medical translator, she knows both the language and the culture, and this has been a huge plus for our team.
Tyler was in Haiti on a medical mission in the year prior to the earthquake. Tyler contacted his friend when we arrived here, and this friend made the all day trip from Port au Prince on a Tat Tat taxi to the MOH front gate. Several hours later, the guards were able to get through to Tyler and his friend was allowed in. Security at this place is a serious matter. Armed guards patrol nightly, and must be trained to not speak to the guests, because a friendly “bon jour” to one in ear’s reach usually results in a blank stare and a quick about face, army issue rifle slung across the shoulder. I’m not complaining.
Tyler’s friend is an orphan, who now has his own son, and as the oldest brother was the primary caretaker for several siblings. As Tyler relayed this story to me today, it struck me that living in a makeshift “tent city” is not living at the bottom of the rung. Desperately trying to get a tent, to then try to get a spot in a tent city, is the tough living. He and his son live now in a lean-to against an abandoned car, its roof a cardboard flat. He sleeps with a machete for protection. This young man is bright and has life plans and dreams in place, but this is his reality now after the earthquake. We pray he finds his brother and sister alive and well.
Mitch was an operating room specialist in the army, and served in Iraq in 2005. That year, his unit was the busiest trauma center in the world. He now manages a 15 room surgical suite in an Austin, has 12 staff under his direction. Having him on this mission has been like having Clint Eastwood with you at a tough guy convention – very wise choice.
Our first surgical patient today was a serious and thoughtful 5 year old girl, admitted last night by Dr. Adrian with a neck abscess and dehydration. Since we had just opened the doors to the clinic, the pre-op area was not full yet, so we were able to play with her, get her giggling, one of the fantastic med/surg nurses from Oklahoma had a bottle of bubbles that we blew, she blew, and I slipped in the Versed during this moment of glee so her last memory before surgery would be a happy one. Her pre-op bay sat up against an open metal-grated window centering a green concrete wall, and just behind her in the grass were a couple of goats that had nosed up close, and they seemed to enjoy us as well.
Our surgical team performed two distal radius fracture cases today, open reduction internal fixations with plates and screws. Both patients had been injured during the earthquake, and neither had been treated to date. Repairing a 4-wk old fracture is technically and physically difficult, as the body has started trying to heal the break by then, and a functioning arm requires good alignment, so great care and effort is made to achieve this. Tyler first assisted these operations today, and Dr. Laura got them both repaired, with excellent prognoses for full functional recovery.
Our last patient tonight was also a victim of the earthquake but not through trauma. He is a young man, paralyzed from the mid-chest down following a gunshot wound to his spine over a year ago. He was in Port au Prince General Hospital on the day of the earthquake, and in the chaos that followed, his family got him out safely. Unfortunately in the weeks since, he developed decubitus ulcers on his back and hips, and presented late today with severe infections and sepsis. In the best of hospitals in the states, this is a problem with a high mortality. We took him to the OR for debridement and wound packing, going through 4 liters of saline with our pulsed lavage irrigator, and removed a significant amount of each wounds’ purulence and necrotic tissue. Dr. Laura, through Viv, then spoke to the family about the gravity of their loved ones situation. One of the pastor volunteers who stayed late into the night with us tonight helped me wheel our critically ill patient into recovery, and offered to pray for him and for us. We gathered together with his family around the stretcher, their dusty colorful frocks alternating with our blue and green surgical scrubs and caps, and prayed for his recovery.
Our ward is packed to overflowing tonight, both medical and surgical patients filling every space. Adrian has the call walkie talkie tonight, and will be available if needed, but with the nursing staff in place here, they will need very little if any help. Tomorrow we are being transported to the Mennonite Mission to do wound care and change out the wound vac sponges. This will take a few hours. We hope to train the staff there how to manage the vacs on their own, and we need to time out dressing changes and orders to fit in with our replacement team, which arrives on Saturday. After this, we are going to Port au Prince. There, we hope to meet some of the doctors and others with whom we have been sharing patients and resources, and learn a bit more about the capabilities of the various facilities. Then, Friday is our last surgical and clinic day, and we will prepare everything for Team 4.
Our travel plans for Saturday are still fluid, Laurence tells us that commercial flights from PAP are not being allowed to land in the US. Our Texas Ortho and HCBC home base will get us home, and until then we will do as much as we can here.
God bless and goodnight.
Robert Wills, M.D.
Austin Pain Associates