with the passage of time

(we are Haiti)

Watching people come full circle has been one of the greatest things I've been able to experience by being here since (almost) the beginning. Little by little, people who came to us very early with horrible wounds are having their very last dressing change, people with severe fractures are having their casts removed and are starting to walk again, and people with external fixators in place have tenative dates for their final removal.

A few days ago, a woman just a few years younger than me came through the gate. Like many others before her, she looked at me with recognition, and I looked at her, flipping through the rolodex of faces in my mind, trying to place her. She told me her name and story and it clicked--she'd made it to our makeshift ER (I believe we picked her up on our truck in one of the slums) on Saturday, January 24th, with a presumed pelvic fracture and hematuria--a concerning combination. We brought her to Terminal Varreux and she was accepted for transfer to the USNS Comfort the same day. I hadn't seen her since then. She's had an external fixator ("ex-fix"--it's lot of metal bars and screws) across the front of her pelvis for the past 6 weeks. She's amazing--still smiling and upbeat after 6 weeks of pretty constant pain and difficulty moving. We took her to Double Harvest Hospital up near Croix-des-Bouquets. They want to wait another 2-3 weeks, and then take off the hardware. I know she was hoping to have all the hardware removed that day, but she understands why she has to wait. It's a bummer I won't be here to watch her get the ex-fix taken off--I would have loved to see that.

The people at Double Harvest Hospital have been absolutely wonderful to work with. Over the past week, we've brought them 20 patients who needed x-rays and orthopedic consultation. The 2 ortho surgeons, Dr. Steve and Dr. Pete, have hearts of gold. Even though we showed up late in the afternoon each day with a truck full of patients, they were always genuinely happy to see us and were so eager and willing to help. It's because of their help and expertise that we've been able to tell many people this past week: "You're done! You can walk again. Everything is healing well." They're both leaving tomorrow morning and they will be missed (thankfully there are other ortho docs coming in from Michigan). Dr. Steve and Dr. Pete revised & adjusted the ex-fix on a 10 year old girl with a femur fracture. They'd initially said there wasn't anything they could do to improve her outcome (her leg was rotated internally), but they mulled it over and decided they needed to try, and the outcome was great. Because of their effort, once her ex-fix comes off in a couple weeks, she'll walk better than she otherwise would have. Thanks Dr. Pete and Dr. Steve!!

Barbie (super awesome ER PA from Alaska who's been here for a month and will be staying through April to finish things out) with Dr. Steve, cutting off Berlancia's cast

Other recent things:
--Tara, Beth, and I were together at the births of 2 baby girls a few days ago. One baby was born around 2:30 PM, and the other around 2:30 AM. Tara and Beth were with the moms constantly for over 24 hours straight. I was able to get a little sleep, as they only woke me up right when the baby was being delivered. Both babies did great. It was SO fun for the 3 of us to work together on these 2 births. Tara left later that day and Beth & I are missing her like crazy.

At Double Harvest on top of our transport truck, on a very unseasonably chilly day

--One of the babies Beth delivered early Wednesday morning was brought back today for her scheduled 3 day check. The baby is unfortunately pretty sick--she has a high fever, jaundice, and is dehydrated. We've got her on IV fluids and IV antibiotics, and will keep her for at least a week to give her a full course of IV antibiotics. We don't have the ability to do things like blood cultures, so we'll give a full course of antibiotic treatment to be safe.



--We still have about 25 inpatients. Most are here mainly for intensive physical therapy (many thanks to our recent PTs Shelly and Ruth, and current PT Brian, who returned on Wednesday after already spending 2 weeks with us back in February), though a number of people still require dressing changes, and we've got 8 people on IV antibiotics around the clock to treat a variety of infections. Between the 8 of them, they're receiving 35 doses of IV antibiotics per day. It definitely keeps the nurses busy. Several of these people on IV antibiotics are being treated for infections related to orthopedic injuries---2 months after the injuries were sustained in the quake.

--Winnie is a Haitian nurse who showed up the day we opened (January 18th) and offered to help. She's been an amazing addition to our team--she is very talented and caring. One of our patients on IV antibiotics is a little 10 year old guy who sustained a horrible crush injury to his face during the quake, but didn't get any care for a month. By the time he made it to the hospital, he had a huge facial/orbital abscess full of botfly larvae. He's required multiple surgeries and over a month of IV antibiotics and anti-fungals. That means he's required many, many IVs. He's such a brave kid and usually does well with getting a new IV put in, but today it was too much for him. At one point I looked over and Winnie was holding him, comforting him, talking to him, calming him down. She is so good with the kids here. And anytime we can hire someone locally, I'm all in favor of it--it provides someone with a job and an income, and we get to work with someone who completely understand the language and culture of the people we're serving.

Winnie with Dina, another one of our patients

--We continue to work closely with MERLIN, a UK-based medical relief organization. I've lost count of the number of skin grafts they've done on our patients. We've got a great system going with them---we typically take patients back to Heartline within a day or two after their surgery, and they send a team out to us twice a week to do all of their dressing changes. It works out great. I've learned more about skin grafts in the past 2 months than I probably would have learned throughout my entire career in the states.

Merlin nurse examining Dina, a girl who had an open tibia fracture and gaping overlying wound...her ex-fix should come off in the next week or two

Healing skin graft

Healing skin graft donor site

--Tonight there was a huge crowd of people outside the hospital gate. Apparently someone (or some organizatino) is doing a food distribution tomorrow morning, and people were lining up tonight in anticipation of the distribution. I've heard about what's happened at other food distribution sites around the city--here's to hoping tomorrow is relatively peaceful outside our gates.

--I'm more and more aware these days of what a privilege it's been to have been a part of something like this. Over the past week I've finally had time to just sit and talk to some of our patients at length. I've talked to all of them to some degree over the past weeks, but this is the first time I've been able to spend lots of uninterrupted time with them. Their stories are amazing, heartbreaking, and every other emotion you can imagine. I will miss these people like crazy. It is going to be very hard to leave Haiti...