DAY THREE - Wednesday, Feb. 3, 2010: Broken bones

Up very early, on the bus by 6:15 am. Interesting to watch the city wake up. We could see the women carrying large bowls on their heads while walking. They would set up shop by unloading the goods in their bowl along the sidewalk and sell them to folks walking by. This is how what little food, clothing, furniture is made available. We also could see each morning long lines of people in lines for rice distribution, or water distribution. Even longer were the lines of Haitians waiting to plead their case at the U.S. Embassy. They had constructed awnings along the waiting line to help shield them from too much sun.

Over the course of my time in Port au Prince, more than one person suggested Haiti would be better off if the US or some other country just took over. One of our team mates, who actually came with the team before me and stayed to work with us, warned us to be careful what comments we made to the parents of Haitian children. She had made a comment to the effect of “she’s so cute, I wish I could take her home.” Her parents paused for a moment, then said “Okay. We’ll miss her, but her life would be better in the U.S.” I can’t even imagine.

At the hospital, I worked in “triage,” which really meant we saw, evaluated, and treated whatever walked through the entrance. For the first few hours, we were furiously doing dressing changes. Many, many Haitians sustained amputations because the resources don’t exist in Haiti to try and save a limb. It would require hospitalizations that are too long and medications that are unaffordable. The risk of infection, though, is so great that most crushed limbs were amputated to ensure a greater chance of survival.

Many Haitians also have broken bones from structures falling on them, and I saw a half-dozen patients myself who were coming in to seek care for fractures that had not yet been treated; this was three weeks after the earthquake. One was a 14-year-old boy brought in by his mom. He was injured in the left ankle and foot the day of the quake. He was seen initially a few days after the quake, but the xray machine wasn’t working. He didn’t have a compound or open fracture so they gave him an Ace wrap and told him to come back if it didn’t improve.

Three weeks later, it was still too swollen and painful to walk on. Our x-ray equipment had become functional again the week before. The verdict? A broken tibia and metatarsal. The kid was walking on a broken foot and ankle for three weeks. It wasn’t aligned perfectly, but the orthopod felt the kid was better off just being casted for three more weeks. To re-break it in order to achieve perfect alignment would have forced him to have additional time unable to bear weight, and since we didn’t have crutches or a wheelchair for him, it would have been too much of a hardship. So he got a cast and I gave him a few dozen ibuprofen.

I changed so many dressings. I couldn’t always tell what I would find underneath. One little girl, about Audrey’s age, had adorable pig tails and a bandage on her left hand. She brought her stuffed bear with her. She was all smiles on her daddy’s lap until I began to unwrap her bandage. She began to cry and ask, in French, for “de l’eau, s’il vous plait.” Water, please. She had had her bandage changed enough to know it was going to hurt, and if I poured water over it, it would hurt less. She whimpered while I finished unwrapping her bandage. When I was done, I felt like whimpering myself. She only had a thumb and pointer finger. The rest of her hand had been sliced off at such an angle that her remaining fingers were mostly gone. After a few minutes of studying her wound, I finally figured out that what I thought was maybe infected material was actually what remained of her proximal phalange.

I remember catching my breath, trying very hard to not look shocked. For all the wounds, we cleaned them with peroxide, put betadine on them, then Neosporin, replaced the wrapping, and said a prayer that it wouldn’t get infected. We wrote the date of the dressing change and any other important details actually on the bandage, so other healthcare providers down the line can have an idea what had previously been done. When I finished her wound, she then pointed to her left knee and wanted me to care for the scrape. Just as tenderly and thoroughly that I had dressed her mangled hand, I cleaned her little-girl-scraped knee and put a Diego band-aid on it. She was thrilled and said, “Merci madame doctor.” I gave her dad an extra band-aid for her knee, and he had tears in his eyes.

The next patient was a little girl about 12, who had her left ankle in a cast. She had a wound on the front of her leg so the cast was left with a hole in it so her wound could be cared for. She was brought in by her dad and aunt and they were very attentive, very interested in seeing the progress her wound was making, and very worried about infection. She was nervous, and clearly was afraid. I stopped cleaning her wound and told her, in the best French I could muster, if I hurt you, say “Hey!” saying the “hey” in English. From that point on, whenever she flinched, I’d stop, look up at her, and ask “Hey?” She’d giggle, say no, and back to work I’d go. I gave her a hug at the end, which started me on a roll of giving out lots of hugs.

The rest of the day went much like that, with dressing changes, xrays, and setting bones. A few patients trickled in with headaches, belly aches, and depression, but mostly under control. At 5:30 pm, back on the bus for a 2-hour ride home. Leftover rice & beans, and into bed well after midnight. That was my last sleep for quite some time.