Yesterday, Duncan and I were in the midst of a serious conversation when I heard a strange noise. I looked over and saw a mouse in our sharps container. I have no idea how he got in there, but it provided our comic relief for the day.
Wednesday morning we were sitting in the clinic, and Duncan or I had probably just muttered something about being bored, when I got a phone call. It was from the YWAM director here, and he was saying something about being at the hospital with a mob of people. He gave instructions to scrub down the clinic and get it ready to take people, just in case. These people were all presenting with severe vomiting and diarrhea. It took us about an hour and a half to clear out a section of the clinic to use as a quarantined area, get supplies ready, and mop. The head nurse bleached the floors and wiped them up herself. As soon as we were finished, a man was carried in. He had a blood pressure of approximately 50/30. We were able to hook him up to two IVs and stabilize him. Two more patients were brought in as well, but were in much better shape. We began rehydrating all of them, then transported them to the hospital.
The past few days have run together a bit, so I can't remember the exact order of events. Sometime very early Thursday morning, Leah heard a helicopter, which indicated that international people were now aware of our situation. And after checking the news websites, we found that the World Health Organization was indeed investigating. I went to the clinic, and we saw an incredible amount of people, simply because they couldn't get into the hospital if they were not presenting specific symptoms. And then it rained again. During the afternoon we simply sat in the clinic. I was pretty frustrated that I was sitting in a chair in an empty clinic while people were dying in front of the hospital gate. Duncan and I discussed this some (he's the practical one) and decided all we could do is make ourselves available for whatever comes.
Yesterday, I believe they gave the official word that we are dealing with cholera. I was on my way to the clinic when I got a call from Terry (director) asking how things were looking at the clinic. He quickly explained that he was setting up some sort of ambulance service and was wondering if Duncan and I could provide care. The clinic staff was fine without our help, so we ran around trying to gather supplies we thought we could possibly need. Then we set out to pick people up who couldn't get to the hospital. Over the next three hours, we picked up four people. We started IVs on three of them as they were severely dehydrated. Thankfully, there was no diarrhea in the ambulance, although a fair amount of vomit was spewed forth. Awesome, as vomit is the one bodily function I don't do well with. But I only gagged once. When we got to the hospital and the ambulance doors were opened, there were people standing there filming us. It was a very strange experience.
We continued to pick people up during the evening until about midnight. Leah and I had decided earlier that we were just going to spend the night at the base. We have no idea how long this will last, so Duncan and I are a little stressed about coming up with a long term plan. But for today we've decided to take shifts. There is a DTS team here from Kona, and there are two nurses on that team who agreed to help us if they are able. The girl who may be going out with me on my shift is also a new graduate. She said she does know how to canulate, but not on Haitian skin. Insert sarcastic comment here. So on our team, I will be the experienced one.
Mom, I know its apple pie filling day at home, and I really dislike cooking and all domestic chores, but perhaps you'd like to switch places with me for today?
Oh, and an update on Velouse, since some of you have been asking. Last weekend, Leah, Audrey and I went to the hospital to see her, but she was nowhere to be found, even after a nurse walked around calling her name. Monday morning she waddled into the clinic. So no baby yet, but I will be sure to update on that.
Saturday, October 23, 2010
Friday, October 15, 2010
Wild West
I think the budget director at EMM had a word with someone in Port-au-Prince, because today the technician showed up and fixed our internet, just in time for me to send in my finance report! (I'll let you remain anonymous unless you want to defend yourself).
This week has been somewhat crazy at the clinic. But I have company now, which is fantastic. Duncan, an ER nurse practitioner from England is living at the base until mid-December and spends the mornings working with us. At one point, I explained to him about how we had a patient last week who desperately needed stitches but there was no one to do them. He responded that he'd teach me how, and I am really really excited about that.
Before I had a chance to learn, though, we had a guy come into the clinic after being in a fight. He had cuts on his head and on his shoulders and steri strips just weren't going to do it. I ran around the clinic looking for the doctor, and after confirming that he left I again asked Yvena if anyone knew how to do stitches. She responded with a "no." I spent 15 minutes trying to call people so I could get Duncan to come back, but to no avail. I returned to where the patient was, trying desperately to figure out what to do. Thats when I found a nurse holding silk and a syringe of lidocaine. Apparently, they don't know how to do stitches, but they do know how to do sutures.
The craziness continued early Wednesday. An elderly man came shuffling through the doors, accompanied by his two daughters. He had a splint on his left arm, but one of the nurses used that arm to take his blood pressure anyways. It was 12/8 (we use only two digits here), or roughly 120/80, which is textbook. He was seen by the doctor and then returned to us. I believe his complaint was a week of diarrhea, so we were going to try to rehydrate him. Dehydration often shows in blood pressure, so the aggressive treatment was a little confusing. Nevertheless, the man needed an IV. I offered to assist the nurse who was going to start it, so I tore tape and got the fluid ready. She stuck him, and even though she didn't get a flash of blood, she took the needle out and wanted me to hook him up. I repeated, "No, no, it's not in the vein" a few times, and after the fluid formed a wheal under his skin, she said, "Oh, yeah," and removed the catheter. Another nurse took a crack at it then, finding three gorgeous veins on his forearm. She got a flash, we hooked up the tubing, and again a wheal formed, indicating that we'd lost the vein. She removed the catheter, and I quickly scooped it up because I am the sharps/biohazard police. I then discovered that she'd never removed the needle from the catheter. Yikes. She made the third attempt on the splinted arm. It was another miss. By this time, I desperately wanted to stick this guy, especially after seeing the veins in his right arm, but am still trying to form relationships and not be overbearing. I heard murmurings of "dokte" and was disappointed that they were really going to wait for the doctor to come try. But then Hermicia looked at me and said, "You can." She then told me I had to wait until he got a drink. While I waited for one of his daughters to bring him back some water, I looked at his paper and discovered that he was 87 years old. She returned then, not with water, but a bottle of beer. This is when I began to feel like I was in the movie Two Mules for Sister Sara, so from here on out I'll refer to this gentleman as "Clint." So Clint explained to his daughter that they stuck him three times and still had to do it again. He drank the entire beer before my needles and I were allowed close to his bed. He also wanted to know my nationality. Then I was permitted to tie the glove around his arm (our tourniquet broke during Hermicia's first attempt). I got the stick, and they frantically tried to hook the line up before I could get the tape to hold it in place. This caused my catheter to come part way out and bend, but it still ran. I went to adjust the rate and was met with protests. The orders were to give Clint 2 liters of fluid, the first liter wide open. By the time he left, his blood pressure was 15/9. Hermicia said, "Good!" Duncan and I didn't really share the sentiment.
Yesterday afternoon we were sitting at the table when a guy ran in covered in blood, holding his head. He may or may not have fallen off a moto, I didn't really get the story. But I got to assist with those stitches. Soon after he left, a girl came in saying she'd fallen and she had a big goose egg and cut on her forehead. After watching someone suture three times, I'm ready to try it myself.
Today was pretty slow, due to the fact that it poured for awhile last night and Haitians will avoid going out in such weather. So this afternoon I was sitting with Hermicia and Anedzia, wishing the minutes away, when Hermicia decided she wanted to practice English. We worked on the days of the week and I started singing the song we learned in Spanish class in high school. So for quite awhile, three 20-something professionals sat around singing the days of the week in English, Spanish, and Creole. During this time, the guy who got stitches yesterday returned because the bandage wasn't staying on his head. I asked the nurses if I could show them something and then introduced them to tegaderms. After he left, I found an ace bandage and showed them how to wrap someones head so to cover the top without the bandage coming off. We all practiced on each other while singing the days of the week song. This is how the receptionist guy found us when he brought another patient in.
Please keep Velouse, one of the nurses, in mind when you pray. She is very pregnant and left the clinic early yesterday. When I asked about her today, they told me that she went in to the hospital and "the baby is coming Saturday or Sunday." I'm not sure how they know that, since they don't induce labor here. But regardless, her husband died a few months ago and Yvena told me that Velouse is scared. Leah and I are going to try to go visit her tomorrow. Hopefully by the time the baby is born I will have figured out how to upload pictures onto this.
This week has been somewhat crazy at the clinic. But I have company now, which is fantastic. Duncan, an ER nurse practitioner from England is living at the base until mid-December and spends the mornings working with us. At one point, I explained to him about how we had a patient last week who desperately needed stitches but there was no one to do them. He responded that he'd teach me how, and I am really really excited about that.
Before I had a chance to learn, though, we had a guy come into the clinic after being in a fight. He had cuts on his head and on his shoulders and steri strips just weren't going to do it. I ran around the clinic looking for the doctor, and after confirming that he left I again asked Yvena if anyone knew how to do stitches. She responded with a "no." I spent 15 minutes trying to call people so I could get Duncan to come back, but to no avail. I returned to where the patient was, trying desperately to figure out what to do. Thats when I found a nurse holding silk and a syringe of lidocaine. Apparently, they don't know how to do stitches, but they do know how to do sutures.
The craziness continued early Wednesday. An elderly man came shuffling through the doors, accompanied by his two daughters. He had a splint on his left arm, but one of the nurses used that arm to take his blood pressure anyways. It was 12/8 (we use only two digits here), or roughly 120/80, which is textbook. He was seen by the doctor and then returned to us. I believe his complaint was a week of diarrhea, so we were going to try to rehydrate him. Dehydration often shows in blood pressure, so the aggressive treatment was a little confusing. Nevertheless, the man needed an IV. I offered to assist the nurse who was going to start it, so I tore tape and got the fluid ready. She stuck him, and even though she didn't get a flash of blood, she took the needle out and wanted me to hook him up. I repeated, "No, no, it's not in the vein" a few times, and after the fluid formed a wheal under his skin, she said, "Oh, yeah," and removed the catheter. Another nurse took a crack at it then, finding three gorgeous veins on his forearm. She got a flash, we hooked up the tubing, and again a wheal formed, indicating that we'd lost the vein. She removed the catheter, and I quickly scooped it up because I am the sharps/biohazard police. I then discovered that she'd never removed the needle from the catheter. Yikes. She made the third attempt on the splinted arm. It was another miss. By this time, I desperately wanted to stick this guy, especially after seeing the veins in his right arm, but am still trying to form relationships and not be overbearing. I heard murmurings of "dokte" and was disappointed that they were really going to wait for the doctor to come try. But then Hermicia looked at me and said, "You can." She then told me I had to wait until he got a drink. While I waited for one of his daughters to bring him back some water, I looked at his paper and discovered that he was 87 years old. She returned then, not with water, but a bottle of beer. This is when I began to feel like I was in the movie Two Mules for Sister Sara, so from here on out I'll refer to this gentleman as "Clint." So Clint explained to his daughter that they stuck him three times and still had to do it again. He drank the entire beer before my needles and I were allowed close to his bed. He also wanted to know my nationality. Then I was permitted to tie the glove around his arm (our tourniquet broke during Hermicia's first attempt). I got the stick, and they frantically tried to hook the line up before I could get the tape to hold it in place. This caused my catheter to come part way out and bend, but it still ran. I went to adjust the rate and was met with protests. The orders were to give Clint 2 liters of fluid, the first liter wide open. By the time he left, his blood pressure was 15/9. Hermicia said, "Good!" Duncan and I didn't really share the sentiment.
Yesterday afternoon we were sitting at the table when a guy ran in covered in blood, holding his head. He may or may not have fallen off a moto, I didn't really get the story. But I got to assist with those stitches. Soon after he left, a girl came in saying she'd fallen and she had a big goose egg and cut on her forehead. After watching someone suture three times, I'm ready to try it myself.
Today was pretty slow, due to the fact that it poured for awhile last night and Haitians will avoid going out in such weather. So this afternoon I was sitting with Hermicia and Anedzia, wishing the minutes away, when Hermicia decided she wanted to practice English. We worked on the days of the week and I started singing the song we learned in Spanish class in high school. So for quite awhile, three 20-something professionals sat around singing the days of the week in English, Spanish, and Creole. During this time, the guy who got stitches yesterday returned because the bandage wasn't staying on his head. I asked the nurses if I could show them something and then introduced them to tegaderms. After he left, I found an ace bandage and showed them how to wrap someones head so to cover the top without the bandage coming off. We all practiced on each other while singing the days of the week song. This is how the receptionist guy found us when he brought another patient in.
Please keep Velouse, one of the nurses, in mind when you pray. She is very pregnant and left the clinic early yesterday. When I asked about her today, they told me that she went in to the hospital and "the baby is coming Saturday or Sunday." I'm not sure how they know that, since they don't induce labor here. But regardless, her husband died a few months ago and Yvena told me that Velouse is scared. Leah and I are going to try to go visit her tomorrow. Hopefully by the time the baby is born I will have figured out how to upload pictures onto this.
Monday, October 11, 2010
Trail Mix
Maybe all those Maytag repairmen who have nothing to do could catch a flight to Haiti and fix our internet. It has been out for three weeks now, and while we did finally get a new modem after two and a half weeks, it'll probably take at least that long for someone to come from Port to actually hook it up. So I will begin this monumental task of trying to write a post on an iPhone.
I just have a random batch of stories to tell, so the title seemed appropriate, seeing as how a lot of you have been camping, either at the apple festival or at camp. I hope they were great weekends, and I was definitely thinking about and missing you all. Also, I was told my dad was dancing?! I sure hope there are pictures. Anyways, moving on...
So the day following my last post, Leah and I were heading out to a tent city to see a list of people Audrey had given us. We only found half of them, but saw many more as we were practically swarmed upon getting out of our vehicle. That morning we went to the clinic to get supplies for the day, and we also wanted to grab some things to remove moto accident man's stitches. Unfortunately, that didn't all go through clearly in the translation. Hermicia thought we were putting stitches in as well, so she gave us silk and a needle. She also handed us a scalpel. We decided we'd just take it all and save everyone further confusion. So after returning from a draining day in the tent city, we walked to this man's house. I discovered too late that the scissors I had were too big to get between the stitches and the skin, but I did manage to get one loose one out. Then I paused, contemplating whether I should just take the shot to my pride and tell him I'd have to come back later. At about the same time, Leah and I remembered that I was still carrying around a scalpel. She was excited. I was not. Sometimes the language barrier is a good thing. I think most patients would be a little less than thrilled if their nurses started nervously praying before coming at their heads with a scalpel. But somehow I got 14 stitches out of this man's head and ear without any further damage occurring. Thankfully we did not need any of the other random supplies we'd been given.
Friday of that week we performed a thoracentesis. I won't go into detail, I'll just include some of my parts. First of all, this was a spectator procedure. All the nurses pulled up chairs. This took place in the triage room, so any other patients who came in also got to watch. At one point, the doctor's phone rang. Haitians always answer their phones because it costs the caller credit. So one of the nurses reached into his pocket, pulled out his phone and held it up to his ear. Something else I enjoyed was how the family of this lady was able to get involved. The doctor had her husband put on gloves and empty the emesis basin of pleural fluid out the side door of the clinic a few times. However, the best part of all this was that at the same time, a few other nurses handed me a 60cc syringe of normal saline which I was to shoot into someones ear to try and get a worm out. We were eventually successful, by the way.
Since coming here, Leah and I have become parents. The guardian here has a 10 year old son who is always in our kitchen. We have successfully taught him to wash dishes using soap, and he enjoys it, which is great except when his enthusiasm causes him to take my plate before I'm done eating. He also likes to straighten things, clearly a trait he inherited from my side of the family. It's tough to "parent" in a different language, as we've had some discipline issues. Leah does all the talking and I give looks (a skill of mine I'm told). This past week we've had some food disappearance problems. One evening Licson was helping me wash dishes and Leah feigned shock over us missing a plantain. He stared at her for awhile and then took her by the hand into the next room and explained how a cat had jumped through the window (our kitchen is on the second floor) and taken our plantain off the counter. I asked him if the cat also opened our fridge and took the kashima fruit. He didn't have an answer for that. So we're still trying to figure out how to deal with that. In the meantime, I've hidden my cookies.
Sometimes I wonder what kind of relationships I'm actually forming at the clinic since we can't actually have real conversations. But I was recently invited to attend a wedding of one of the nurses next month. Yvena told me, "All the medicine people, we'll all go together." Does anyone believe that I have a dress to wear to this wedding but I don't have shoes?
I just have a random batch of stories to tell, so the title seemed appropriate, seeing as how a lot of you have been camping, either at the apple festival or at camp. I hope they were great weekends, and I was definitely thinking about and missing you all. Also, I was told my dad was dancing?! I sure hope there are pictures. Anyways, moving on...
So the day following my last post, Leah and I were heading out to a tent city to see a list of people Audrey had given us. We only found half of them, but saw many more as we were practically swarmed upon getting out of our vehicle. That morning we went to the clinic to get supplies for the day, and we also wanted to grab some things to remove moto accident man's stitches. Unfortunately, that didn't all go through clearly in the translation. Hermicia thought we were putting stitches in as well, so she gave us silk and a needle. She also handed us a scalpel. We decided we'd just take it all and save everyone further confusion. So after returning from a draining day in the tent city, we walked to this man's house. I discovered too late that the scissors I had were too big to get between the stitches and the skin, but I did manage to get one loose one out. Then I paused, contemplating whether I should just take the shot to my pride and tell him I'd have to come back later. At about the same time, Leah and I remembered that I was still carrying around a scalpel. She was excited. I was not. Sometimes the language barrier is a good thing. I think most patients would be a little less than thrilled if their nurses started nervously praying before coming at their heads with a scalpel. But somehow I got 14 stitches out of this man's head and ear without any further damage occurring. Thankfully we did not need any of the other random supplies we'd been given.
Friday of that week we performed a thoracentesis. I won't go into detail, I'll just include some of my parts. First of all, this was a spectator procedure. All the nurses pulled up chairs. This took place in the triage room, so any other patients who came in also got to watch. At one point, the doctor's phone rang. Haitians always answer their phones because it costs the caller credit. So one of the nurses reached into his pocket, pulled out his phone and held it up to his ear. Something else I enjoyed was how the family of this lady was able to get involved. The doctor had her husband put on gloves and empty the emesis basin of pleural fluid out the side door of the clinic a few times. However, the best part of all this was that at the same time, a few other nurses handed me a 60cc syringe of normal saline which I was to shoot into someones ear to try and get a worm out. We were eventually successful, by the way.
Since coming here, Leah and I have become parents. The guardian here has a 10 year old son who is always in our kitchen. We have successfully taught him to wash dishes using soap, and he enjoys it, which is great except when his enthusiasm causes him to take my plate before I'm done eating. He also likes to straighten things, clearly a trait he inherited from my side of the family. It's tough to "parent" in a different language, as we've had some discipline issues. Leah does all the talking and I give looks (a skill of mine I'm told). This past week we've had some food disappearance problems. One evening Licson was helping me wash dishes and Leah feigned shock over us missing a plantain. He stared at her for awhile and then took her by the hand into the next room and explained how a cat had jumped through the window (our kitchen is on the second floor) and taken our plantain off the counter. I asked him if the cat also opened our fridge and took the kashima fruit. He didn't have an answer for that. So we're still trying to figure out how to deal with that. In the meantime, I've hidden my cookies.
Sometimes I wonder what kind of relationships I'm actually forming at the clinic since we can't actually have real conversations. But I was recently invited to attend a wedding of one of the nurses next month. Yvena told me, "All the medicine people, we'll all go together." Does anyone believe that I have a dress to wear to this wedding but I don't have shoes?
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