Day One Ortho clinic, Monday 2/28/11

Here is my first full recap of Day One Ortho clinic, Since this recap, I have completed two more days. While the work load is never ending, it is also very fascinating and an experience that I'm glad to be doing. While the group I'm with are very different from me, they are really good people. Hopefully will have more time to write tomorrow. Only 2 more clinic days left.

Today was the first day of “work”. The tradition is to attend church in the morning at 7:45 and pray with the patients and their families. The music, singing is very moving. They sing from their hearts and the harmony all of the voices in harmony moved me to tears. The Haitians were intrigued by our presence. Many eyes following me across the room. I am the only woman on the trip not “praying” so I stand out a bit. Able to get some video of service to capture the feeling.

Quick rounds/review in the hospital. Families bathing their loved one, cleaning up from the night before; bed mats, sheets on floor, etc. Patients are admitted into the hospital and remain inpatients for reasons that have longed stopped in the US. Clearly no DRGS in Haiti. Examples would include comminuted radius fractures, patella fractures wired together. Then there are the truly complicated patients with multi extremity issues, many of which are old and not healing. Failed ORIF’s, patients with compression syndromes from poor cast placement. Severely fractured pelvis’s being treated with traction pins through the tibia and weights hanging off of the bed. The spirits in the hospital are a little more skeptical. They have been lying in bed feeling ”sick” for a long time. JL’s boot camp will be a shock to the system. My approach: get them up any way they can, ambulate them to outside and treat as many outside as possible to change the environment. The hospital is dark, 8 to a room plus family. Hard to do much at any bedside as a PT; here impossible!!

Off to clinic…The doctors head to the OR and I have an interpreter, Monaville, who will spend the day with me. Let the chaos begin. Complete and utter chaos. There is no system to how cases are triaged and at the same time, the order of patients being seen is not related to first come, first serve…It is far more disorganized and random at the same time. Patients do have to pay for everything being done; X-rays, cortisone shots, medicine, etc. This is not a free clinic. More about that later.

The clinic has two plinths up against the wall with “clean”sheets on each. One has a very firm cushion which is supposed to be the pillow. There is one stool, two chairs which are loaded with things left over from prior clinic days. (x-rays, x-ray frames, “medical records”, etc. The overall feeling put out by the Haitians is hard to describe; a little hopelessness mixed with unrealistic expectations while being detached from their bodies and lacking self initiative to “heal thyself”. I have never had a such a hard time getting people to “move their bodies”. It is not a language barrier. It is the worst body awareness I have ever experienced in any population to date. A BIG PT challenge…

So here is the typical scenario encountered on day one: Patient comes in to clinic with litle to no history written on why they are here. I have to do a full history and ask endless questions trying to get to the reason they chose today to come to ortho clinic. While I am doing this, there is constant interruptions at the door with constant knocking and people wanting to “negotiate” their way to be seen next. Most patients have more than one area of complaint and there is no telling them chose one. So after history and exam, I may have time to actually treat and teach a few things for them to do so unfortunately they miss out on the part of “heal thyself” and thus the pattern continues. I ask over and over again” how important is it to you to get better/full function back? I hear an unconvincing “very important” and try to explain to each patient that he/she will need to endure some pain to get a contractured extremity moving again. I forgot to mention that patients who present with a new problem need x-ray and I write the order for X-ray. Some have had x-ray done before I see them. By the large majority x-rays are over exposed, missing the most important feature you are looking for : label put right over area of issue, over developed right where you need clarity. SO….many need to have x-ray repeated. Clearly the person developing and or shooting the x-ray is not bothering to actually look at developed picture and do a “quality control assessment”. In the states, an ortho would have shot the tech by the third crappy x-ray!

Twenty patients before lunch, I have no idea how. They line to be seen is growing, my interpreter is politely wondering if there will be a break. Little does he know I could work straight through. Bur we do break at 1:15 and agree to return at 2:00. Patients who I have questions about will be seen by the docs at 2:00 before they start a case. Patients are there all day. Part of the helpless mindset.

The afternoon continues much the same as the morning. I have never seen more complicated cases with so many not healing. And at the same time, once again the same surprise exists that what is seen on film and how a patient presents is often shocking. The film would have you believe you have a non ambulating person and yet the patient is somehow managing to walk (with many deficits) on their non healed fractures, pseudoarthrosis, etc.

After a long day; stopped at 6:30, I return to guest house to learn no running water. Okay….After dinner, the lights start to dim and then….no electricity…..Welcome to Haiti! I finish the day taking my cold shower with my “lantern” flashlight (thank god I had it) and go to bed.

Haiti Medical Trip