News from Dr. Bill, Tuesday 3/30/10

I got done with surgery not too badly today, about 8:30 pm, then had a bunch of patients to sort out in the hospital with Drs. William, Morose and Adult. Overall, doing well. Frenel is going home tomorrow, (my first amputation), then coming back in a few months to be the first amputee to get a prosthesis, the Lord willing and the program cooperating. The lady with the buttock loss, who had virtually nothing on the right side due to crushing injuries, has healed pretty well, only about a 6 inch by 2 inch by 1/2 inch deep hole left, it is a bit gunky, but hope we can clean this back up.

I saw my ruptured appendix back in the clinic today, one tough lady, she had walked around with the rupture for 2 months before she came to me, had been to 2 different hospitals without the right diagnosis, not that it is always that easy to diagnose here. She looked great, at 46, minimal scar, and wanted to know if she could get rid of restrictions of any sort. Very encouraging to see her. We continue to see delayed problems, a lot of nonunions of fractures treated who knows how. We had one that had an open reduction with plating, then went to the leaf doctor for treatment (using herbal remedies, poultices, etc) now has burned the skin and has infection in the hardware/metal inside the arm. A real problem anywhere, especially here.

The trip here was rather uneventful, thankfully. The baggage delivery system in the warehouse can only be described as total chaos. The bags are unceremoniously tossed through the opening in the larger steel doors and then are supposed to be brought to a central storage area, but it essentially turns into a free for all. I was rather glad that I had both yellow duct tape stripes and the grey ones, as many had one or the other but not both, there must have been at least 500 bags just tossed everywhere. I had the spinal anesthesia and Ketamine well packed, my most prized commodities, as doing surgery both here and for the team at Bonne Fin would be difficult without that. We did find a little spinal for sale here in Cayes, about 4 times the price per dose and no where near as good quality, so thanks to Keith Knepp for finding it for me. I am hoping to get it ordered from IDA in Amsterdam soon, but haven’t heard if Herby, the customs clearing agent, has returned since the quake.

As mentioned, the patients that are now coming from the quake are more chronic ones with nerve damage from the crush injuries, many of whom have still rather painful memories of the friends that didn’t make it and seem traumatized psychologically as well as physically. It is harder to encourage these to push themselves to try to regain function. Sometimes, the Haitian attitude of “Si Bon Dieu le veut,” (if good God wills It) is great, as they can better adjust to the difficult fate that awaits them here in this struggling country. However, from a rehabilitation standpoint, it can be rather frustrating to try to maintain function while waiting the months it may take for nerves to regrow as much as they possibly can. The same attitude can be rather fatalistic and not produce much effort.

A team that arrived last week Wednesday or so for our sister hospital, Bonne Fin, said their volume has reduced considerably. Ours is still up, though more manageable. However, the injured are still stumbling in, especially since some have heard that we are gearing up to do more physiotherapy and prosthetic work. Although I am technically responsible for that aspect, I am also technically challenged and will oversee it only as needed from the medical standpoint. We are still providing a solid meal daily to each patient and some of the family members, this has been a real encouragement to them. We try to provide high protein intake, with beans, some meat, etc, plus the daily fare of rice. No one seems to complain about the limited variety and the cooking takes place right behind my bedroom, so it smells nice even hours after the food is done. Of course, I am known to eat anything and everything around, so maybe that isn’t as impressive an observation. Hopefully we will be shipping a large amount of rice on the next container to go, as we can get it for around 1/4 the price here.