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Update from Dr. Patton
Posted on February 25th, 2010 No commentsTuesday AM
Another quake. 4.7 at 1:27 am. I didn’t get out of bed. It wasn’t bad enough. I have the Haitian trots this AM. Not good.Wednesday PM
I have been working part time since I got the trots. I wish I could work more but I feel weak as the day wears on.
Today I removed 6 casts. I taught my friend and Haitian interpreter, Jean, to remove them. He learns quickly. One young lady had a cast that ended at the fracture site on her humerus. Of course it had not healed. There is so much work yet to be done.A young boy burned his foot. It had been dressed but that dressing had not been changed in days. Pus dripped from the wound. It needed cleaning in the OR. The family could not be persuaded that the surgeon would not cut his foot completely off. They left without allowing any intervention. I hope they come back before the child becomes septic and loses his life or at best now his limb.
I so enjoy Scott Nelson’s vision.
Feeling feverish and weak. I hope tonight passes quickly.
H2O traction in a tent. “Welcome to Haiti.”
IV fluids in. Miserable day.
My buddy, Jaunty, brought me a protein milk shake. What a great guy!
The owner of these cute, dimpled hands can count to twelve!
I am impressed at the older and cleanliness of many of the people despite the surrounding chaos and filth.
This little boys spine is protruding because it has been destroyed by tuberculosis.
This is a common sight.
...a lot of metal to hold together a destroyed pelvis.
Without C-arm there was no way to know if this fixator was on straight in the OR.
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Everybody’s leaving but we’re still here
Posted on February 24th, 2010 No commentsHello blog-o-sphere, sorry it's been so long since I've made a post. Seems every time we think things are getting better we are dealt a new deck of cards. We have been as busy as ever here but with new and varying challenges. While post-op ortho cases are gradually being discharged and leaving the property we have been plagued with significant traffic in our ER. To make matters worse it seems that more and more NGOs and government groups alike are ending their Haiti relief missions already. What this means is that our ability to transfer patients out to places that may have resources we don't is dwindling and will soon be gone. Our two best transfer options for critical patients have been the USS Comfort and the University of Miami Field Hospital. Word on the street and confirmed by our own challenges in transferring patients to either, is that both will be ending their missions here in Haiti shortly. By default, we have become the regional trauma center for the entire west side of Port au Prince and most of the communities on the western peninsula. This was never our intent and we are ill equipped for such responsibility but, we will carry on and are committed to the Haitian communities we serve.
Sorry to be cynical but apparently the collective goal of many response agencies working here was to: return Haiti's health care system to the pre-quake state and then go home. Well folks we (LLU and the volunteer groups that have and continue to work here) exceeded that goal just by showing up. The idea that that goal is an acceptable level makes me want to scream. This nation has lost upwards of 225,000 people, almost 1 million of the surviving population are without proper food, water, shelter, or sanitation and somewhere between 7,000 - 10,000 have had limbs amputated, not to mention the huge number of patients with surgically treated injuries. To think that the international community can come here for 6 weeks and then turn their backs is simply unacceptable. LLU is not leaving our work here in Haiti and we continue to need your support. Please if you have the means to help our work, click on the red button at the top of this blog and support our cause.
Aftershocks
We have had two 4.7 aftershocks this week both in the middle of the night. Significant aftershocks continue to be a very real reality here and are detrimental to the already fragile psyche of the Haitian population and our volunteer medical staff. During an aftershock our patients in the hospital all go running and screaming out of the building, many dragging their IVs on the ground or ripping them out all together. This is a major obstacle for us to overcome.
Shelving update
I am pleased to report that we have more than 20 shelving units built and in use in the various operational units around the hospital. We have more shelves being built and more on the way. This one simple thing has radically improved the efficiency of our operation.
BCFS Texas Strike Team
We have been blessed for almost two weeks now to have a group of volunteers from San Antonio Texas here at the hospital with us. This team is a highly trained incident management team (IMT) that have worked in multiple disaster zones such as Hurricanes Katrina, Ike, 9/11 and others. They have helped us implement an Incident Command System (ICS) structure that has dramatically increased the efficiency of our relief effort. We have implemented specific roles that each of us play in order to decrease overlap of duty and maximize productivity. ICS stresses the creation and dissemination of very specific objectives to be completed in each 24 hour period. These objectives are shared twice a day at 7:30AM and 7:30PM in a very structured staff briefing. Overall this system seems to be steering us rapidly towards our goal of resuming normal hospital operations inside the building. Much work remains but ICS has been very helpful in moving us forward.
The Chief and The Commander in their ICS vests
Numbers
70 post-op patients still outside in the tents
15 patients inside the various wards in the main building
21 sick babies
10 pregnant moms waiting to deliver
16 volunteer staff with GI issues in the last week
18 hour work days still the norm for Andrew
Keep Haiti in your prayers and thoughts as much work remains here. -
Puder the Tall Checking In
Posted on February 23rd, 2010 1 commentToday I woke up feverish in a sweat to the shaking of the earth. I am on doxy malaria prophylaxis but added chloroquine today. The residual fatigue is getting to me, but as the day went on I felt stronger. I had a new doctor who worked ER triage so I slowly made my rounds making sure things in the ER were moving forward and people getting meds, improving, etc. One of my big projects today was using a translator to make sure the Haitian nurses knew how we were writting orders. Dr. Nelson arrived today. Good to see the doc that got me excited about Haiti!
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News from Dr. Patton
Posted on February 23rd, 2010 No commentsThis afternoon I made rounds through the tents with a general surgeon from Martinique. He is an angel! His goal is to help motivate the patients to return to there homes and begin to rebuild rather than remain in a tent on the hospital lawn. Every family and widow responded, “we need a tent to set up on the street outside our house”. They have nowhere to go. Dozens of families. I heard the exact story repeatedly.
The mobile dressing and casting cases I made were wheeled through the camp today to care fore those in the tents.
The surgeon amputated an infected foot.
The Ortho team rode to the hotel where CNN reporters and other VIPs stay in a “top-top”. It’s a pick up with a topper raised by metal bars to allow the passengers to ride in the bed of the pickup, sitting on parallel facing benches yet covered with truck bed topper: top-top. We survived.
I had a wonderful conversation with Andrew Hagland about the story of the first few days of establishing this hospital as the premier medical faciltiy in Haiti post quake.
Scott Nelson arrives tomorrow.
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Tough Day
Posted on February 23rd, 2010 1 comment
Today’s events:
- ER triage;
- a cardiologist helped me diagnose a girl who looks pregnant with (per echo) biventricular heart failure with a 20% ef;
- called a code as a woman came in vomiting up blood;
- worked with Haitians on organizing the er pharmacy;
- packed a gun shot wound;
- took a pregnancy test to make sure it works (I’m not pregnant);
- made difficult decisions;
- prayed to God for help;
- worked dirrectly in consults with surgeons and ortho;
- treated a severe asthma exacerbation;
- drained some abscesses;
- delt with stress related psychosomatic issues;
- worked with some excellent nurses;
- got to know some translators;
- and loving it!
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Out of the Rubble – Blog
Posted on February 22nd, 2010 No commentsAndrew wanted us to let you know about a blog that myself, Michael Wolcott, and Cosmin Cosma have. The blog is called Out of the Rubble and it's a behind the scenes look at the documentary that we're filming based here at Hopital Adventiste d'Haiti. We try and get pictures and small videos up as much as possible. -
Organizing the ER
Posted on February 21st, 2010 1 commentAnother 7 am to 845 pm day in the Er. Today I woke up on a mission, and got to work organizing the er. We have 4 areas, and I put a doctor and a nurse in each area. Luckily we had enough people mid day to do this from 9 to five. I then worked with a retired ob doc on planning out the pharmacy. Before it was endlessly frustrating to find anything, but now we have a plan of attack, and a map at the doorway. I also ran around doing things which others could not like interact with the lab, ob ward, ect, things I have learned in the past week. An er doc and I made assessments on post op patients, one with pneumonia, another not as anemic as the lab thinks (clinical opinion is best). Then a team of doctors and nurses, 6 total, left at 4pm, and all of a sudden several very sick patients showed up. A pneumonia with double pneumothorax took up a considerable amount of time, even finding all the supplies! No time to organize when people are crashing! Alfonso has been doing the night shifts in the er, and feels a little sick.
Many of the diseases I am seeing are the result of the Haitians living in close proximity in the streets, psychological stress, infectious diseases, broken bones or musculoskeletal pain from the event, and long term issues that have never been addressed.
Pray for us!
The morning
Full attention to a crashing patient. One general surgeon, one icu doctor, one anesthisiologist...
"Directly observed antimalarial therapy"
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Last Night
Posted on February 21st, 2010 No commentsWe hung out in the ER for a few hours last night, but like usual when we’re there it’s slow. But, in peds an approximately 27-week-old baby came in. She was born in the camp outside the hospital, she still had some dirt on her. Every effort was made to transfer her to a medical facility that could provide life support but none could be found. The nurse on duty called a doctor in the US to get some advice, the doctor gave her a 50 percent chance of surviving the night. At 1:30am the baby was doing good but the mother was running a fever.
We made it until about 2am and then crashed, we'd been up for over 20 hours (not counting a short nap).
Today the plan is to get some interviews, talk with a patient outside who lost his leg and has a wife and two small children, and spend some more time with Sebastien. -
Night Shift
Posted on February 21st, 2010 No commentsThe internet has been down for a little while, this post is from early yesterday evening.
Tonight we’re going to hang out in the ER, the night shift. We’ll see how long we last (it was an early morning). We’re going to try and go on a transport or two. Seems like the transports usually go to the Miami Field Hospital or the USS Comfort. When they leave transports will probably come to this hospital. We’ll bring along Cosmin’s LED Cool Light and it could be a good low light test for the 7d.
This morning we rode along on an airport trip. One of the orthopedic surgeons was heading home. We drove through downtown, saw the palace and the devastation around Port-au-Prince. -
Organizations Impressed
Posted on February 19th, 2010 No commentsThe Pan American Health Organization (PAHO) and the United States Agency for International Development (USAID) have visited the campus in the last few days. All indications are that when some of the temporary medical facilities leave Haiti, Hopital Adventiste d’Haiti will be the most advanced hospital in the country. Among the many reasons for this is the water filtration system. Once the system is up and running this might be the only hospital in the country to have potable water running through it’s pipes. Another big reason is the condition of the campus, the hospital building is in great shape. Perhaps the most important reason is the relationship between Adventist Health International, Loma Linda University, and Haiti. AHI and LLU have had a presence here in Haiti and they will continue be here in the future. When some of the more advanced medical facilities leave Haiti, this hospital will most likely be the place where critical patients are sent. The Haitian people working along side the volunteers have made tremendous strides since the earthquake making this hospital one that the people of Haiti can turn to in the midst of this crisis.
