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.

Little girl sleeping on floor

This little girl sleeps on the floor of the hospital keeping her dad company. Bad picture, beautiful little girl. Just finished evening rounds. Tomorrow we have around 30 inpatients needing PT. They are expecting 20 outpatients tomorrow who are post op follow up earthquake victims. I have been asked to do all screening as docs are in OR.

I have 4 people working under me (pTA's and OT). Should be a busy day.

Hope to sleep better tonight; last night rooster crowed ALL night. Then the two dogs got in to a fight with the rooster around 3:00am......

2-27-2011 haiti
Click to view photo location in Google Maps


Haiti first impressions

We arrived and got through customs quickly - not much concern for what you are bringing in here. Once outside (hot, humid, 80's, I'm loving it), the haggling begins. Forty to fifty men trying to get you to use their vehicle. We had a prearranged van for all 10 of us. Luggage on top strapped down. The chain link fence separating Haiti from the airport has young boys begging you to give them money. Once outside the airport the rule of the road is the bigger the car and the louder the horn ==> the right of way. Horns are used like doorbells to announce your presence. Constant honking the whole way. A few streets away from the airport we were in a congested area. Lots of people on streets, many approaching the van. One person in our van saw the shadow of a person up on top of our van, pulling at the ropes. We all got a little concerned...ok very concerned. The bus driver then explained we had a hired person on top of van "to keep luggage tied". That was a HUGE relief.

As you ride through Port-au-Prince there is no sign that things have been cleaned up other than the streets are cleared, mostly. Building after building toppled and tents set up around the rubble. People live literally on top of one another. Existing structures are attached, 6x6' and stack up from street back to who knows where. So before earthquake, the people living in this area were already living on top of one another. No privacy. Areas with tent camps have the tents attached to one another... Again, 6x6, stacked together.

What did catch my eye is the interesting tin used for entry ways and garage doors. The kind of tin with imprints that I would like to arrange to ship home and use somewhere in my 9x9 house! The tin and iron grates are decorative.

What's most decorative are the tap tap buses. Painted, decorated, usually religiously themed but not always. The owners of the buses compete with design to be the best tap tap bus. This guarantees more ridership. People pile on, and I mean pile. The highlight was catching up to the Barack Obama tap tap bus. My favorite!

The damage from the earthquake was visible through the first 90 minutes of our ride. Now we weren't driving fast but even still, the damage was far-reaching.

At one point we started driving through the country, very lush, reminds me of Costa Rica. Every few miles you ride in to a little bazaar with street side vendors. I could not convince them to let me out and look around for hidden treasures. Dogs run along the road and cars/buses honk at them. That's the only warning they get so unfortunately I got to see the tap tap bus ahead of us hit a dog and kill it.........

We drove to the southwest area of the island called Calles. We were met by the group leader Sheila. The van would never make it up the steep winding road to hospital.

Everyone out, loaded luggage in to jeep, and all but me climbed on TOP of jeep to ride up the mountain. I rode in jeep next to Sheila. She has lived here for almost 3 years. I really like her spirit. That’s me behind the jeep in the photo below.

guest house arrival

The guest house is quite livable. Five bedrooms, 3 baths sometimes with running water (cold). We have two house staff who cooked a great dinner. I passed on the goat but otherwise liked the rice, beans, cole slaw, tomatoes, chicken, plantain and coconut cookie.
view from reservoir

After dinner we went to hospital to round on all 50 patients and a few in ER. Rooms have 6-8 patients plus family. It is not unusual for a family member to sleep under the bed of a loved one to care for them.

Wow diabetes – not the American variety from poor diet and obesity. These people are thin. Diabetic ulcers that don't heal and after several failed attempts to debride, end up with amputations. All ages, men and woman.

Trauma fractures from vehicle accidents. Motorcycle (the no helmet varieties) with head trauma as an added bonus. Lots of badly displaced fractures, some open through the skin. Pins, plates, bone traction with weights hanging off bed. BEDREST for 4 plus weeks. A PT nightmare. No get em up and move them day 1. Severe deconditioning, atrophy, and yes, decubiti... more bad healing. Every patient here has been referred to me to design a program. Noah will be doing some tendon releases to free up contractures caused by immobility. The patients are comfortable for the most part. Not a lot of pain meds here. Lots of smiles. One boy here for a displaced tibia fracture from a bad soccer play, is adorable. He will have surgery Monday to fixate his fracture and then he's all mine. Most like my current population!!!

The hardest case was a young girl 2-3, with a fractured radius. Taken to an herbalist who wrapped her arm too tight and resulted in a compartment syndrome. She is in pain. Huge tears and crying when her bandages were removed...and she cried too. Big tears, fear in her eyes, screaming from pain. Surgery for her. Many beanie babies and toys are coming to her. She is beautiful.... and her mother very present.

On walk back to house, I spotted a beautiful toad/frog... I knew Eric was with me!!! Others went to look for tarantulas in the rocks. I passed on that...

All for now.....

Arrived in Haiti

So much to take in. The devastation and how people are living right around it, on it, over it... Took about 6 hours to get to hospital. The ride was a very interesting experience.

The hospital has 50 patients needing various surgeries related to diabetic ulcers needing amputations, trauma fractures, a few earthquake follow-ups procedures for failed cases.

Many, many stories already. The CA gang is great...

Haiti Medical Trip