Haiti, Day Six

Day six was less about considering the condition of the people here and more about working as hard as I could. I began to realize how little time I had left and didn’t want to waste a single minute of this precious gift of being here. I have to be sure that Owen Ala, a fellow resident my year at UNM, gets credit for helping the people of Haiti. I was scheduled to be on call day six and seven back in New Mexico. Owen had some stressful things going on in his life, on top of being a busy resident. He had been on call a few unlucky weeks in a row and I asked him to add another one on top of that. It was not easy for him, but he did it for me. If he had not done that, I would have probably had to leave three days earlier to make it back in time to be on call at UNM back home. He allowed me to extend my trip by about 1/3 and those days were filled with work that needed to be done. He is directly responsible for helping the people of Haiti during this time, even though he never got on a plane. Thanks.

Dr. ____ (need to find where i wrote down his name) is a second-year resident, like me. We were able to work together for some of the time. It is interesting to know that the principles being taught are, for the most part, the same all over the world. The difference is that while he reads about some fancy fixation devices and techniques, we actually have access to use them in the states. The table in front of us was where we piled all of the donated external fixator parts we had. It felt a little like building Legos: scrounging around in a pile of parts looking for the perfect component to finish off the creation.

So many people were still streaming in with serious injuries, even now, weeks after the initial devastation. External fixator devices, as stated in an earlier post, were an essential method of treatment for long-bone fractures (tibia, femur, and others). They allow health-care workers to take care of wounds if the fracture is open (what used to be called “compound” or with bone injury and soft tissue around the fracture). A patient can even walk on a leg that has one of these contraptions in place until the bone heals completely. This is as opposed to a cast, which covers up a possibly festering wound and is not stiff enough to allow walking.

Drilling the pins into the tibia (shin bone). You can see a bunch of anesthesia equipment behind us. That’s all fine and dandy when there is electricity. A few times a day, the power would just go out. There was still light because the top two feet of the walls were open to the sunlight and we had our headlamps. However, what do you do when you’ve got a patient asleep with a machine keeping him alive? The anesthesiologist starts squeezing the bellows by hand until the power comes back. Sometimes that took hours.

Here’s the assembly of the Erector Set/Lego creation.

You can see how close the other operating table is to ours. There was a general surgery case there and the young man had peritonitis (bacterial infection in the lining of the abdominal cavity). The general surgery resident from Chicago had done his best to clean it out. The young guy was so unstable, they left him asleep under anesthesia for a few hours while we did a number of other cases a few feet away. At some point, we heard the ominous beeping, signaling that he was dropping his blood pressure and oxygen saturation. Zach Child, the gen surg resident and I discussed the case and we coded him (CPR and other last-ditch efforts) for a few minutes. He was too far gone, the infection had spread too much and we lost him. He was a young, otherwise healthy-looking man, except that now he was gone from this corner of the world so acquainted with suffering and death.

This is the final ex-fix construct. I am actually doing a research study on this unique triangular configuration I came up with that is particularly suited to emergency work in 3^rd world countries with limited resources. It uses the most common parts (regular pins, clamps and rods) and does not require x-ray imaging while being put on (which we didn’t have). It also doesn’t require the pins to all be placed precisely, as all other constructs commonly used require. The triangle can always be assembled, no matter how the pins are placed into the bone. The key benefit is that the triangle also allows us to easily adjust the alignment of the bones after the patient has gone to the other building to get x-rays to see how we did. Good alignment is the whole point of the procedure and all other constructs (except those that use expensive components that aren’t available in 3^rd world countries) are not fully adjustable in all directions and planes. Lastly, when final alignment is achieved, the construct can be made as strong or stronger than other commonly used constructs with a few finalizing modifications. Hopefully, this will be able to help someone else during the next similarly horrific disaster in some other part of the world.

Since there was such fast turnover of physicians and support staff, it was essential to write the plan for the wound care directly onto the dressing. It also served to remind me how little time I had left that I was writing dates for the following week when I would be back in my air-conditioned, clean and new hospital at UNM (month/day in case you were wondering if the dressing was to be changed in 7 months).

This is an open tibia fracture that did not receive treatment and was now 3 weeks out. It had started to heal, but the bone was still sticking out of the skin, drying up and dying. The guy was a little crazy, so his delay in presenting to the hospital was understandable since those of sound mind came in with untreated injuries weeks later also. He was going to need an operation to shave down the exposed bone and cover it with soft tissue, but I don’t know what eventually happened to him. You may think that my goal is to gross out the reader, but it’s not. You also haven’t seen the picture below, which is much worse (or better, depending on your perspective).

The ER tent sent someone up asking that someone from ortho come down to see a bad wound. I came down and pulled back the dressing to find this. There were over a hundred maggots in this woman’s serious foot wound. While it looks disturbing, she probably had the cleanest wound in all of Haiti. Her wound will probably heal in secondarily (from the inside out) better than any of the many other infected, necrotic wounds with we dealt with.

A guy in his 20s came in with a shoulder that he had dislocated 3 weeks before during he earthquake. At least that was his story. We made a few attempts to put it back in by giving him pain meds and pulling on it. When it was clear it was not going to go in, we decided to take him to the OR and open it up. That’s when we realized that he probably had this dislocation for months or years before the earthquake. We were able to get it back in place after a good deal of soft tissue dissection, but his shoulder will be far from perfect. We actually saw a lot of people who had old injuries and came in looking for help. We were glad to do what we could, but it changes our plan for intervention when the injury is chronic or acute. No big deal, we actually get the same stories in New Mexico all the time.

Tomorrow is my last day. I feel like I did when my mission in Uruguay for my church was ending, after having been there for two years. In Uruguay, I started waking up a half hour early every day to finish reading some books I wanted to finish before going home. I would walk so fast that my companions had to almost run to keep up. I can't stand not finishing all-out. Haiti made that difficult, though. We were not allowed to be out of our military compound after dark because of the very real dangers all around us. If people thought Haiti was a dangerous place to be before the earthquake, you take that same deviant sliver of society and place them in these conditions and you get a whole new level of social misfits. I would work feverishly around the hospital, but the moment when they told us the troop carrier was leaving was always too soon. I hated going back to the camp to sit around and eat and swat away mosquitoes. It was nice to recap the day with Mike and my Dad and find out what they were able to do that day, but there was so little time and so much needed to be done. If all 25 residents in our UNM program had come down and worked around the clock, there would still have been a ton left to do at the end of our time.