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?
Monday, September 20, 2010
Ambulatory Trauma
After my last post, I was chastised by someone with an intense fear of needles for not including a warning that I was telling stories involving needles. So let me state that right off the bat: this post involves needles.
I also need to preface this by saying that Yvena, the only English-speaking nurse, had today off. Another nurse, Hermicia, was helping out and she is in the "first grade of English." Other than that, this was a fairly normal day at the clinic (maybe "typical" would be a better word). Around noon, a woman was carried in. She had a thermos with her which was holding vials of insulin. I took her blood pressure and temperature and then we kind of moved her off to the side (she'd had a leg amputated so we didn't make her move around a lot). She sat in the corner for close to an hour. Then things like a liter of saline and a liter of 5% dextrose started appearing on the table. I was pretty confused as to why we were going to pump her full of dextrose if we were also giving her insulin, but then after some rapid Creole, the dextrose was replaced with a liter of saline with potassium. Mind you, it is after 1pm at this point, and the clinic closes at 3. And if people have IVs running and its getting close to 3, the nurses speed them up so we can get out on time. Then a random assortment of needles is thrown onto the table. I see 18gauge first. That is a fairly big needle, considering the size of this woman. The other ones were 22g, my nemesis needle. The needle I used when I missed my first IV. The needle that doesn't show a flash of blood until its just about too late. I feel validated in this because my mom also said they can be tricky (maybe she was trying to make me feel better, but we'll go with it).
"Sarah!" The woman's veins were officially mine now. I put the tourniquet on. I can sort of see some really tiny squiggly veins in her hand, but nothing I liked, so I moved it up above her elbow. When no veins popped up at all, I broke out in a sweat. I think it was at this point that the woman started removing her clothes with the tourniquet still on her arm. I tried telling her that wasn't necessary, but to no avail. Eventually I got my tourniquet back and put it on the other arm. Nothing. Moved it again. Something that I thought might be a vein showed up on her arm, so I went for it. Me and the 18g needle. It was a miss. So I went hunting for veins again. There was a tiny one in her hand that looked like the best option. I was handed the 22g, and by this time, a crowd of nurses is gathering. So I stuck this poor woman again, and just when I was about to take it out because I just wasn't getting it, I got a flash of blood. Then starts the chaos. Another nurse takes the needle, I'm still holding the catheter in place with my hand, and yet another nurse is trying to hook up the saline with potassium (nevermind that I can practically hear instructors yelling at me for even opening the packaging without knowing the woman's labs). Then the patient starts pumping her hand like I had her do when I was looking for veins. So I'm trying to tell her to stop, hold the catheter, and get someone to give me tape. All the while, the roosters are going crazy outside. Hermicia started speaking to me in rapid Creole at this point until I ended up nearly yelling, "Hermicia! TAPE!" By that time it was too late. The catheter was bent and partially out of her hand, and no amount of adjusting could get it back in.
For some reason, they handed me another needle. This was when the head nurse showed up. Sweet woman, but just the title makes her intimidating to me. So I went back to the other arm. Found another vein and stuck her for third time, officially making her a pincushion. I missed. The head nurse tried moving it around, but we ended up taking it out. I threw in my gloves at this point, and the head nurse took over. I felt a little better about myself when she looked at the patient's arms for awhile and all she could say was, "Oh, piti! [small]". She stuck this woman twice. And yet a third nurse went to work on this woman. She stuck her three or four times before she finally got the line in. Overall, it was a mildly traumatic afternoon for me, and I wasn't even the one being repeatedly stuck. But that lady was quite the trooper.
I got home and stopped in the kitchen on my way up. Leah and I sat down at the table while I was eating my snack, and then she got a phone call. I was pretty intent on my banana and trying to fix the damage she'd done to the peanut butter by just digging into the middle of the jar and didn't really notice what she was saying. She hung up and said, "You're going to go clean wounds on a man with spinal cord injuries." Shortly after, we were picked up by Audrey (YWAM staff who was previously involved with the clinic) and taken to this man's house. Here, it was the same man who came to the clinic last week with lots of random cuts and stitches on his head and ear. It was there that I went from RN to MD. This man has intense pain in his neck and back, radiating down into his arms, and can hardly walk. I cleaned his wounds and then his wife handed me his xrays. I have no idea how to read an xray. But I didn't see anything sticking out of somewhere it shouldn't be or anything like that. I asked Leah about MRIs, but she said it's not an option in this country. So I asked what he was given at the clinic. He was a recipient of the basic package: ibuprofen, tylenol, amoxicillin, and vitamin c. So I'm prescribing him some muscle relaxants for now, which he'll get tomorrow when I go back to take his stitches out. Praise the Lord, all his lacerations are clean and nicely healed.
What I truly intended for this post to be was an update on my transportation situation, since that was the only specific prayer request I had before leaving. This morning on my way to the clinic I was trying to think of what to post about since certain members of my family get a little excited if I wait too long. And I decided transportation was the topic since nothing too exciting has happened in the last few days. (And by that I mean I've gotten used to the fact that every day is some sort of adventure). So that's the last time I'll think that I've gotten used to life here. Anyways, I pretty much have stable transportation to the clinic each day. Leah and I found these two moto drivers who are pretty reliable, fair, and safe. So one of them has been outside our house each morning to take me. This morning neither could take me, but the one was still outside to say he had someone else he knew who would. The afternoons have definitely been a lot more of an adventure. I'll spare the details for my mother's sake, but I have made it home safely (eventually) each day. It's almost more fun this way, just because God has provided something different every day, but there's always something. However, something stable would be appreciated as well. In the meantime, the nurses have taken to staying until they make sure I'm on a moto and the driver knows where my house is. I believe I've now perfected how to hold on with one hand and hold my skirt down with the other. And I think I've discovered the pecking order for street use around here. Pedestrians are at the bottom, trumped by pedestrians with wheelbarrows. Above them is bicyclists, then motos. Motos are trumped by cars, cars by trucks, and trucks by busses. The coke truck trumps all, unless there is a goat involved. Or if a fight breaks out in the street. But that's a story for when I'm on US soil again.
I also need to preface this by saying that Yvena, the only English-speaking nurse, had today off. Another nurse, Hermicia, was helping out and she is in the "first grade of English." Other than that, this was a fairly normal day at the clinic (maybe "typical" would be a better word). Around noon, a woman was carried in. She had a thermos with her which was holding vials of insulin. I took her blood pressure and temperature and then we kind of moved her off to the side (she'd had a leg amputated so we didn't make her move around a lot). She sat in the corner for close to an hour. Then things like a liter of saline and a liter of 5% dextrose started appearing on the table. I was pretty confused as to why we were going to pump her full of dextrose if we were also giving her insulin, but then after some rapid Creole, the dextrose was replaced with a liter of saline with potassium. Mind you, it is after 1pm at this point, and the clinic closes at 3. And if people have IVs running and its getting close to 3, the nurses speed them up so we can get out on time. Then a random assortment of needles is thrown onto the table. I see 18gauge first. That is a fairly big needle, considering the size of this woman. The other ones were 22g, my nemesis needle. The needle I used when I missed my first IV. The needle that doesn't show a flash of blood until its just about too late. I feel validated in this because my mom also said they can be tricky (maybe she was trying to make me feel better, but we'll go with it).
"Sarah!" The woman's veins were officially mine now. I put the tourniquet on. I can sort of see some really tiny squiggly veins in her hand, but nothing I liked, so I moved it up above her elbow. When no veins popped up at all, I broke out in a sweat. I think it was at this point that the woman started removing her clothes with the tourniquet still on her arm. I tried telling her that wasn't necessary, but to no avail. Eventually I got my tourniquet back and put it on the other arm. Nothing. Moved it again. Something that I thought might be a vein showed up on her arm, so I went for it. Me and the 18g needle. It was a miss. So I went hunting for veins again. There was a tiny one in her hand that looked like the best option. I was handed the 22g, and by this time, a crowd of nurses is gathering. So I stuck this poor woman again, and just when I was about to take it out because I just wasn't getting it, I got a flash of blood. Then starts the chaos. Another nurse takes the needle, I'm still holding the catheter in place with my hand, and yet another nurse is trying to hook up the saline with potassium (nevermind that I can practically hear instructors yelling at me for even opening the packaging without knowing the woman's labs). Then the patient starts pumping her hand like I had her do when I was looking for veins. So I'm trying to tell her to stop, hold the catheter, and get someone to give me tape. All the while, the roosters are going crazy outside. Hermicia started speaking to me in rapid Creole at this point until I ended up nearly yelling, "Hermicia! TAPE!" By that time it was too late. The catheter was bent and partially out of her hand, and no amount of adjusting could get it back in.
For some reason, they handed me another needle. This was when the head nurse showed up. Sweet woman, but just the title makes her intimidating to me. So I went back to the other arm. Found another vein and stuck her for third time, officially making her a pincushion. I missed. The head nurse tried moving it around, but we ended up taking it out. I threw in my gloves at this point, and the head nurse took over. I felt a little better about myself when she looked at the patient's arms for awhile and all she could say was, "Oh, piti! [small]". She stuck this woman twice. And yet a third nurse went to work on this woman. She stuck her three or four times before she finally got the line in. Overall, it was a mildly traumatic afternoon for me, and I wasn't even the one being repeatedly stuck. But that lady was quite the trooper.
I got home and stopped in the kitchen on my way up. Leah and I sat down at the table while I was eating my snack, and then she got a phone call. I was pretty intent on my banana and trying to fix the damage she'd done to the peanut butter by just digging into the middle of the jar and didn't really notice what she was saying. She hung up and said, "You're going to go clean wounds on a man with spinal cord injuries." Shortly after, we were picked up by Audrey (YWAM staff who was previously involved with the clinic) and taken to this man's house. Here, it was the same man who came to the clinic last week with lots of random cuts and stitches on his head and ear. It was there that I went from RN to MD. This man has intense pain in his neck and back, radiating down into his arms, and can hardly walk. I cleaned his wounds and then his wife handed me his xrays. I have no idea how to read an xray. But I didn't see anything sticking out of somewhere it shouldn't be or anything like that. I asked Leah about MRIs, but she said it's not an option in this country. So I asked what he was given at the clinic. He was a recipient of the basic package: ibuprofen, tylenol, amoxicillin, and vitamin c. So I'm prescribing him some muscle relaxants for now, which he'll get tomorrow when I go back to take his stitches out. Praise the Lord, all his lacerations are clean and nicely healed.
What I truly intended for this post to be was an update on my transportation situation, since that was the only specific prayer request I had before leaving. This morning on my way to the clinic I was trying to think of what to post about since certain members of my family get a little excited if I wait too long. And I decided transportation was the topic since nothing too exciting has happened in the last few days. (And by that I mean I've gotten used to the fact that every day is some sort of adventure). So that's the last time I'll think that I've gotten used to life here. Anyways, I pretty much have stable transportation to the clinic each day. Leah and I found these two moto drivers who are pretty reliable, fair, and safe. So one of them has been outside our house each morning to take me. This morning neither could take me, but the one was still outside to say he had someone else he knew who would. The afternoons have definitely been a lot more of an adventure. I'll spare the details for my mother's sake, but I have made it home safely (eventually) each day. It's almost more fun this way, just because God has provided something different every day, but there's always something. However, something stable would be appreciated as well. In the meantime, the nurses have taken to staying until they make sure I'm on a moto and the driver knows where my house is. I believe I've now perfected how to hold on with one hand and hold my skirt down with the other. And I think I've discovered the pecking order for street use around here. Pedestrians are at the bottom, trumped by pedestrians with wheelbarrows. Above them is bicyclists, then motos. Motos are trumped by cars, cars by trucks, and trucks by busses. The coke truck trumps all, unless there is a goat involved. Or if a fight breaks out in the street. But that's a story for when I'm on US soil again.
Wednesday, September 15, 2010
Trilingual Trifecta
Yesterday was my first day at the clinic. My understanding was that I'd be observing and kind of getting a feel for what goes on there. But they just put me to work, and that was fine because otherwise I would've been bored. I was taking temperatures and blood pressures and subsequently added the words "arm up" and "arm down" to my creole vocabulary. There is one nurse who speaks a fair amount of English and another who speaks Spanish and a tiny bit of English, so between the three of us I get some instructions and we manage to have a little bit of conversation. The Spanish speaking nurse, Stephane, works in the pharmacy, and I spent the second half of the day with her. There I learned to say "one/two/three a day."
Today was an incredibly interesting day. I was taking temps and BPs when these two kids bring their dad in with a towel over his head, looking like he is in a lot of pain. The nurse said, "Sarah, come. You clean and I hand you things." I removed bandages and gauze (which had dried to his head) to find lots of random abrasions and stitches all over one side of this man's head, including his ear. So we cleaned and rebandaged, and that's all I know. I have no idea how the injury happened, and no idea if he got any pain meds, antibiotics, etc. Then there was a boy with wounds on the bottom of his foot. While I was going through in my head what type of dressing would be best, I discovered that we have a pretty simple system used for all injuries. My choice of peroxide or saline, then betadine, then neosporin. He left in flip flops, walking on his toes.
I didn't have much time to think about that, because there was a guy in line behind him. I didn't see any wounds or bandages. Then I hear, "Sarah, IV medication." During the 90 seconds it took to get on my vinyl, non-powdered gloves in the Haitian heat, I checked this guy over and over again for any sign of a heplock. After being positive there wasn't one, but in the rational moment I had before my heart started pounding, I thought I'd double check with the nurse mixing up the anti-infective. "Sooooo you stick this...right in the vein?" "Yes, wherever you can find." Fantastic. Someone found a tourniquet, and we checked out his hand. I wasn't impressed. In fact, I was starting to freak out. Perhaps if the needle hadn't been an inch and a half long, I might've tried the one tiny little crooked vein on the side of his hand. But probably not. So we moved the tourniquet up above his elbow. A single vein popped up, but it was a good one, except for the valve. But I somehow managed to get this needle in, and then I pushed the med, torn between whether I should give it slow because I knew it probably shouldn't go in too fast and just pushing because I knew it had to hurt a whole lot. I think it's safe to say that he and I were both a little shaky afterwards. When I got back to the house, I checked my med book: Ancef - give over 30-60 minutes.
The saddest part of my day was the boy that came in next. I unwrapped his leg (it's like a surprise every time, I never know what I'll find) and found three stitches on the side of his knee. He looked mostly healed, and he said there was no pain, but the edges weren't together right. He should've had about four more stitches. They were handing me tweezers and scissors, and I asked how long the stitches had been in, hoping to stall. But he got them over a week ago. So basically, every time I cut a stitch, I was praying that the Lord will heal his knee up correctly because otherwise it won't happen. Peroxide, betadine, neosporin, and hoping the bandage was tight enough to keep him from bending his leg too much. Then he left.
Last night a cousin or someone asked me about food. I said I know for sure we won't go hungry, but we pretty much just have our daily bread. Then this morning when we were getting ready, I told Leah that it would be great to have peanut butter and jelly to take for lunch, but I grabbed my power bar and guacamole and went outside to get my taxi. Leah called me right as I was leaving the clinic to ask me something, then said, "By the way, there's three boxes in our kitchen with food in them." I ran up to the kitchen when I got back, and, of course, found jars of peanut butter and jelly in one of these boxes. And just as a bonus, another box had beef broth in it. Thank you Jesus for caring about the little things.
Today was an incredibly interesting day. I was taking temps and BPs when these two kids bring their dad in with a towel over his head, looking like he is in a lot of pain. The nurse said, "Sarah, come. You clean and I hand you things." I removed bandages and gauze (which had dried to his head) to find lots of random abrasions and stitches all over one side of this man's head, including his ear. So we cleaned and rebandaged, and that's all I know. I have no idea how the injury happened, and no idea if he got any pain meds, antibiotics, etc. Then there was a boy with wounds on the bottom of his foot. While I was going through in my head what type of dressing would be best, I discovered that we have a pretty simple system used for all injuries. My choice of peroxide or saline, then betadine, then neosporin. He left in flip flops, walking on his toes.
I didn't have much time to think about that, because there was a guy in line behind him. I didn't see any wounds or bandages. Then I hear, "Sarah, IV medication." During the 90 seconds it took to get on my vinyl, non-powdered gloves in the Haitian heat, I checked this guy over and over again for any sign of a heplock. After being positive there wasn't one, but in the rational moment I had before my heart started pounding, I thought I'd double check with the nurse mixing up the anti-infective. "Sooooo you stick this...right in the vein?" "Yes, wherever you can find." Fantastic. Someone found a tourniquet, and we checked out his hand. I wasn't impressed. In fact, I was starting to freak out. Perhaps if the needle hadn't been an inch and a half long, I might've tried the one tiny little crooked vein on the side of his hand. But probably not. So we moved the tourniquet up above his elbow. A single vein popped up, but it was a good one, except for the valve. But I somehow managed to get this needle in, and then I pushed the med, torn between whether I should give it slow because I knew it probably shouldn't go in too fast and just pushing because I knew it had to hurt a whole lot. I think it's safe to say that he and I were both a little shaky afterwards. When I got back to the house, I checked my med book: Ancef - give over 30-60 minutes.
The saddest part of my day was the boy that came in next. I unwrapped his leg (it's like a surprise every time, I never know what I'll find) and found three stitches on the side of his knee. He looked mostly healed, and he said there was no pain, but the edges weren't together right. He should've had about four more stitches. They were handing me tweezers and scissors, and I asked how long the stitches had been in, hoping to stall. But he got them over a week ago. So basically, every time I cut a stitch, I was praying that the Lord will heal his knee up correctly because otherwise it won't happen. Peroxide, betadine, neosporin, and hoping the bandage was tight enough to keep him from bending his leg too much. Then he left.
Last night a cousin or someone asked me about food. I said I know for sure we won't go hungry, but we pretty much just have our daily bread. Then this morning when we were getting ready, I told Leah that it would be great to have peanut butter and jelly to take for lunch, but I grabbed my power bar and guacamole and went outside to get my taxi. Leah called me right as I was leaving the clinic to ask me something, then said, "By the way, there's three boxes in our kitchen with food in them." I ran up to the kitchen when I got back, and, of course, found jars of peanut butter and jelly in one of these boxes. And just as a bonus, another box had beef broth in it. Thank you Jesus for caring about the little things.
Friday, September 10, 2010
No Hablo Creole
We arrived safely in Haiti this afternoon, as did all our luggage. Trying to keep our luggage in our possession until we found our driver was a bit more of a challenge. I more or less ended up fighting this man for my luggage cart, even though Leah kept telling him we weren't going to pay him. So we compromised and both pushed my cart at the same time. After our two hour drive along the coast to our house, Patrick, one of Leah's friends, came and picked us up and took us to the base where there was food waiting for us. I have met my match with hot sauce. The bottle says, "One drop does it" but I failed to read that until I'd drowned my fries in it. I met some more people at the base, and some of them find it particularly amusing that I don't speak a lick of Creole. So instead, they speak to me in Spanish. That way, I can verbalize how I don't understand them.
We're headed to the market in the morning since our cupboards and fridge are bare. And morning is going to come too soon for this night owl. But I don't anticipate having too much trouble sleeping despite the music, dogs, and goats outside my windows.
We're headed to the market in the morning since our cupboards and fridge are bare. And morning is going to come too soon for this night owl. But I don't anticipate having too much trouble sleeping despite the music, dogs, and goats outside my windows.
Thursday, September 9, 2010
Why Do Today...
I would just like it said that while I may be leaving in a little less than three hours and am not completely packed, I did bring down the suitcase and start packing this morning. Or yesterday morning. That sounds even more productive.
There is something to be said for procrastination. Certain cousins of mine (J&J, E&L) delivered their notecards to me this morning, and because these cards were assumed lost, other people wrote cards for those days, so now I have two notecards for multiple days!
Anyways, I'll be arriving in Haiti around 3pm tomorrow (4pm PA time, for those who asked about a time difference), and then who knows what. As I discussed these [non]plans with the Grosh family Monday night, Jesse commented that our family has people all over the world who have no idea what they're doing. So I should be fine. (Am I right, Jin and Kent?)
There is something to be said for procrastination. Certain cousins of mine (J&J, E&L) delivered their notecards to me this morning, and because these cards were assumed lost, other people wrote cards for those days, so now I have two notecards for multiple days!
Anyways, I'll be arriving in Haiti around 3pm tomorrow (4pm PA time, for those who asked about a time difference), and then who knows what. As I discussed these [non]plans with the Grosh family Monday night, Jesse commented that our family has people all over the world who have no idea what they're doing. So I should be fine. (Am I right, Jin and Kent?)
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