Hello from Haiti to everyone! Well first thing is to address the situation in Haiti and how it affects the clinic. I’m sure you all have been reading the news, so I won’t go into great detail. The gangs in Port au Prince have been causing trouble for years making it unsafe for us to go to Port and expensive to transport medications and other supplies from Port. In the last month they have combined in an effort to overthrow the last remnants of the government in Haiti. Over the weekend the violence has escalated dramatically with attacks on the airport in Port to prevent the prime minister from returning. They have also launched concerted attacks on police stations and broke open 2 prisons releasing an estimated 4,000 more violent bandits. Port is in complete turmoil at the moment. This makes it impossible for us to buy medications and other supplies in Port. However, we were able to go to Fond Parisien Friday and buy gas, propane, diesel, and medications from the Dominican. The clinic is well stocked to go without more supplies for several months. Hopefully then the situation will have calmed down. The other effect this has on the clinic is on patients that need a higher level of care. If we or the hospital in Fond Parisien can’t help, they have no other options. This puts much more pressure on us to do everything we can here. As to our security here, the mountains remain calm and peaceful. The gangs need to pass Ganthier before they can reach Fond Parisien and the road up the mountain. So far they haven’t been able to pass Ganthier. As long as it stays like this, we are safe here. If the gangs were to pass Ganthier, we can go down the other side of the mountain and cross into the Dominican at Pedernales. The markets here still have food available. The prices are high and this makes it difficult for the poorer people to buy. There is so much need here, but sometimes it feels like there is so little we can do. And the rest of the country is in much more dire conditions, yet the international community does nothing. Pray for this country and for us.
2 weeks ago we had a 31 year old woman come in with significant swelling to her abdomen and legs. Blood pressure was a little high. We gave her medications for her blood pressure and furosemide, a diuretic, to help take off the fluid. She came back that Thursday, much worse, struggling to breathe. I told her she should go to a bigger hospital, but they said they had no money. I thought about taking her to Fond Parisien by ambulance, but I didn’t know what they could do for her. Ultrasound showed she had large bilateral pleural effusions. Over the summer we did a paracentesis to drain fluid off a patient’s abdomen. Then we sent her to the hospital in Fond Parisien for further workup. They sent her home and said they didn’t have a doctor that could do a paracentesis. Yet nurses at a clinic in the mountains could? Oh well. With that memory in mind and nowhere else to send her, I decided to try a thoracentesis to drain the pleural effusions. This involves sticking a large needle between the ribs into the pleural space to drain the fluid. The needle is withdrawn and a catheter stays in place so the needle doesn’t harm the lung. Care must be taken to avoid puncturing the lung and sterility is vital to avoid an infection. For all these reasons I was afraid to try it, but she clearly needed it. So I set up with nurses and Kelson’s help. Without ultrasound to help avoid the lung and the liver I would not have done it. I’m very thankful for that ultrasound. The procedure went well, and we drained 1,200 ml in total off both sides. Afterwards, she looked much better. She was breathing normally and able to eat. Without being able to do more of a workup it is hard to know what caused the problem. Postpartum cardiomyopathy is a problem, but her last baby was a year ago. I gave her metoprolol to slow her heart and lower her blood pressure, lisinopril to help with her blood pressure, and furosemide to help reduce fluid retention. She came back the following Monday, still doing OK. Her pleural effusions looked a little worse, but I sent her home. She lives close, so she was able to come back Thursday for a checkup. This time she was having more trouble breathing, so I repeated the thoracentesis. This time I was able to draw 750ml off the right side. After her pleural effusions were almost completely gone. We gave her the option of going by helicopter to Mirebalias. The hospital there is much cheaper than the ones in Port. They said they would think about it and let me know. However, over the weekend the gangs attacked the airport in Port and now it is closed. She will come back tomorrow for a check up.
THORACENTESIS
Last Wednesday we had an unresponsive patient brought to the clinic. He is 45 years old. His wife said he went out to the garden to take care of the animals, when he came back to the house he drank a Toro (a Haitian energy drink). Afterwards he said he had a headache, then had trouble walking and finally collapsed. He was completely unresponsive and barely breathing. At home we would have intubated him and placed him on a vent before taking him to CT. But here? I suspected a stroke. I wasn’t sure what was the point, but I set up a BVM, connected it to oxygen, and started assisting his breathing. I also had to keep suctioning him, because he had a LOT of secretions. His initial oxygen level was 5%. (Congratulations sir, officially the lowest I have EVER seen.) After a bit his oxygen level started coming up. Then he started trying to breathe on his own. Eventually I was able to stop bagging him and switch to an oxygen mask. He still wasn’t acting appropriately. Watching him, I wondered if I had resuscitated him only for him to have an anoxic brain injury. After speaking to the wife and family more, they told me he had a brain surgery in the Dominican 12 years ago after an accident. I started thinking maybe he had a seizure. They said he never had a seizure before (props to this family for the best medical history I’ve ever received here). This would make it more likely for him to have a seizure. Maybe not eating or drinking much before drinking the Toro triggered a seizure? I told them he should go to Port to speak with a neuro doctor and have a head CT. I contacted Haiti Air. They asked if the family had $400 for a CT. That’s a bargain by American standards, but a lot of money here. They didn’t. I prayed the prayer I often pray, “God, help me know what to do to help”. The patient was having violent tremors. It didn’t look like any seizure, but I decided to give him Diazepam IV just in case. This seemed to help his neuro status improve. He started talking and was oriented! I finished giving him a liter of fluids and was able to remove the oxygen. He staggered out with a man on each side supporting him. I still wasn’t sure what the cause was but gave him seizure medication to take at home just in case. I also gave him antibiotics in case he aspirated while I was bagging him. This morning he came into the clinic, walking on his own, perfectly fine! It was amazing to see! Nothing like shaking the hand of a man I almost gave up for dead to make your day. An amazing and humbling experience. Miracles still happen.
One of our after hours visits was a little boy who fell on some metal. He had a large cut on his head with skull exposed. While irrigating the wound, we could see the skull had a scratch. Kelson did a good job suturing. The boy came back a week later and the cut had healed beautifully.
We were able to take the cast off the boy with the broken leg. I just checked on him. He is walking with a limp, but able to put weight on it. I encouraged him to keep walking, and he should do well. Thank you again for your support!