Day By Day in Haiti

Day By Day in Haiti

Joshua B Weil, MD

Winter 2011 - Volume 15 Number 1

Day 5: A list

Things I really appreciate having here:

  • A shower
  • A toilet
  • A mat to sleep on
  • No rain while sleeping outdoors
  • At least one good meal per day and generally a good supply of sufficient food and drinking water
  • A generator with a few hours of electricity each day

Things I will always try not to take for granted in the future:

  • Ice
  • A hot shower
  • A running shower (as opposed to wetting down, shower off, soaping up, rinsing off—I took a bucket shower with < 5 cups of water)
  • Not being devoured by mosquitoes
  • Food always available
  • Clean drinking water
  • Electricity every time I flip the switch
  • Sanitation
  • A comfortable lifestyle and relative safety for my family

Less acute trauma, more wound checks and an increase in medical complaints and infectious disease: fevers, diarrheas, coughs. One very sick teenager, probably with pneumonia. Two patients with complicated post-burn problems that needed more definitive intervention than they received initially and now needed surgical debridement. Certainly aware of the mental consequences of the trauma: lots of people complaining of "palpitations" and other anxiety-related issues. The latter is hardly surprising, but seems always somewhat different in its manifestations culturally. It’s also interesting how urban legends arise out of these situations: in Sri Lanka people were afraid to eat fish because of fear that the fish had been eating people killed in the tsunami, likewise here people are now shying away from meat afraid that the animals have been eating the dead.

139 patients today.

Day 8: First day of mobile clinic

I wonder at what point you become used to feeling your body at less than its best. I have bug bites on my feet, hands, back, and forehead. I’m not bitten badly compared to many, but I do have some nagging itching. I’m constantly sticky from sweat. Even minutes after showering (thank goodness I can shower every day) I begin to feel sweaty again. I have a rash on my thighs, I presume from heat. My body is holding up well, in general, no neck pain from sleeping funny or particular joint aches. It would just be nice if my skin came around.

146 patients at base clinic, 114 at mobile, 260 total.

Day By Day in HaitiDay 9: "But my urine is yellow"

Switched teams today, I stayed at base clinic while others went out on the mobile team. At times it seems like some patients come in simply because we’re here, it’s free, and they can get free medications. They go down a list of complaints until they hit something for which we can give them medications: "I have flu (a cold)." Okay, so that’s a virus, will get better on its own. "But my urine is yellow." Yes, that’s normal. "What about my ‘heartburn.’" Okay, winner, we can give you some meds for that.

Today I did see a young girl with a complex laceration now about two weeks old. She had some wound on the side of her face that had been repaired, but a quarter-plus-sized hole on her forehead that was open to the skull. I hesitated because it was so old, but felt it really needed to be repaired. Would have loved to have some sedation, but we don’t have anything available right now. So under local, with limited tools and not quite the suture material I would have preferred, I undertook the repair. I debrided back the margins to give some fresh tissue for the closure, undermined the skin so I could close the gap, and closed the muscle over the skull. I think it looked pretty good under the conditions, but it was difficult without the sedation. I hope it holds up.

181 patients at base clinic, 85 at mobile, 266 total.

Day 10: Death of a clinic child

With hundreds of thousands already dead from this disaster no doubt we’ve lost some patients. But for the most part we don’t know the outcome with the patients we transfer to other hospitals. However today early in the day at our mobile clinic a woman presented with her ill infant. The child had a history of hydrocephalus and had a significantly deformed head from same with a shunt in place. She was grunting but did not look that bad when my colleague, Vivian, asked me what I thought. We both thought she was best served at a hospital with some dehydration and respiratory compromise and a presenting complaint of hematuria, but we didn’t think she looked that terrible. She was loaded into a car for the ride with another of our team, Don, the retired dentist who’s throwing himself into being a jack-of-all-trades for this mission. Upon arriving at the hospital which was clearly still overwhelmed they were apparently redirected several times before finding the appropriate ward where the child promptly arrested and died during the hand off. Those of us in medicine and especially emergency medicine deal with the death of patients with some regularity, but for Don it was new. I don’t think it was an experience he had ever had before and it will take some processing. Even for the rest of us it was still a bit shocking since we hadn’t pegged her as that ill. We reviewed the circumstances and I really don’t think there was anything we could have done differently under our current conditions to change the outcome. Will think about that one for a while, though.

201 patients at base clinic, 165 at mobile, 366 total.

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