DAY FOUR - Thursday, Feb. 4, 2010: Long day, long night

The bus left at 6 am in an attempt to miss traffic, but the plan didn’t work very well. It still took 2 hours. There is simply more traffic than Haiti’s already overburdened roadways could handle.

I worked in triage all day, with more dressings, and wounds. I got to play a little with Elefan, a little 3-year-old living in the hospital with his parents, 2-year-old brother, and baby brother while the youngest received intravenous antibiotics for an infected skin graft. The little baby almost died last week, and the team before ours was very preoccupied with him. We inherited that concern, plus an immediate affection for Elefan. He ran freely around the hospital, and I think everyone on our team has at least one photo with him. His brother was discharged the last day we were in Haiti, and the entire staff was grateful for his brother’s health but worried about what the family would do now that they were re-entering the world of the tent cities.

At 5 pm, I went to staff the 7-12 bed ICU. How many beds were crammed in there depended entirely on how busy the hospital was. I’d say capacity by American standards was about 6. I had agreed to stay overnight and work to staff triage, but didn’t realize until everyone was leaving that the intent was that I would run the ICU, too. The ICU wasn’t like where I’d trained in the states, it was basically just patients waking up from late afternoons surgeries and anyone who actually required monitoring, since the Haitian nurses who staffed the hospital wards at night were grossly overwhelmed. We were supposed to have a Haitian nurse as a 3rd person to help us, and to translate, but that nurse never materialized. So, we frantically tried to get our patients to the bathroom, get them pain meds, assess how they were doing, all with my limited French.

I had been fluent in French 15 years ago, after I studied abroad for six months. I had never known any medical French, though, and my French was really spotty from lack of use. I quickly learned how to give IV meds, look up how to mix meds in a pharmacology book, and struggled to find the right French words to take care of patients. It was non-stop frantic activity until after midnight, then we slowly got the patients settled in.

Betty, the lovely nurse with whom I was working, who was 62 and hanging right in there, literally tucked each patient in and sang lullabies. The ICU was air conditioned, per US standards to keep infection down, but we were freezing the Haitian patients, most of whom didn’t have blankets since it was expected they would bring linens with them. We scavenged the hospital and ended up using some packing material and drapes from the OR to get the patients comfortable.

Around 2 am, we had drawn up a list of supplies we needed, and I went to explore the pharmacy. I managed to find extra bags of IV fluids, although some in Russian, some in Spanish, some were from Korea. In the US, different specialties argue about which IV fluids are best. In Haiti, it didn’t matter. If it was fluid, you hung it.

In the US, we would generally have an IV in place but not have fluids constantly running unless necessary. In Haiti, we didn’t have the right supplies to “hep lock” IVs, since we didn’t have heparin. If IV fluids weren’t running, the IV would clot off. That worked out ok, since nearly every patient was dehydrated. I think I figured out we gave every patient 3-4 liters of fluid overnight.

Come dawn’s early light, our patients were finally pain free, we were exhausted, and we gladly toppled on to the bus at 9 am to go back to the compound. Before I left, though, I prepared one final patient for discharge. He was a 6-year-old little boy named Pierre who had an inguinal hernia. He had been seen in triage a week or so before, and was told to come back for the surgery to repair it. However, fractures and amputations picked back up and so he was sent home. His mom brought him back once more to see if his hernia could be repaired now. They had squeezed his surgery in at 9 pm, and since there was no way for the family to get back to their patch of dirt in the park after dark, they had stayed the night.

The mom had a baby at “home” who was nursing. Again, my French lacking much, we fumbled through a conversation where she requested some sort of container to manually express milk into. I wondered if the baby would have something to eat while his mom was at the hospital.

In the morning, the baby brother appeared. His mom asked me for a diaper. I traipsed around the hospital, asking if we had any. One aid worker showed me a semi-hidden room with a stash of random donations and boxes that hadn’t yet been sorted through. One corner of the room had boxes of diapers wrapped around baby food, and some bottled water. I found a little box and filled it with jars, water, diapers, and water. I took it back to the ICU and pulled Pierre’s mom outside, away from the rest of the patients and families. We had been told to be very careful when distributing things like this, because if we didn’t have enough for every patient around it might cause frustration. Worse, if word got out we were doing some sort of distribution, crowds would quickly form.

In the best French I could muster, I told her she could not say anything to anyone, but showed her the contents of the box. She smiled a huge smile and got teary eyed. I told her she absolutely couldn’t smile that big or cry. It didn’t do any good. She hugged me, kept saying “Grace a Dieu” and we went back to her son’s bedside. About $20 worth of stuff, maybe 2 days of supplies. I wondered how long she would make it stretch to.

One final run through of the discharge instructions once the interpreter was found, and they were off.