And then there were 4 …

We arrived early at St. Luke’s on Thursday, as it was one of our two Clinic days for this week. There were almost 400 patients for the Clinic or the ED alone. Nicole worked in Triage, ensuring that the patients were placed in the right spot. Traditionally, the patients are made to wait, and then wait some more, and then wait even more. We have tried to give the nurses some criteria for more effective triage practices. They have made huge progress in the past year and we are seeing an increase in the sense of urgency. Much work to still do but progress is a sign of hope.

Cat and Jenna gave two lectures on Lab Values and basic diagnostic testing. The goal is to get the nurses to be more assertive and recognize or predict the problem and course of treatment based on vital signs and the patient presentations. Hours could go by with the doctor not yet seeing the patient. They liked the term “Get the ball rolling,” and were saying it in English, since they were not quite sure how to translate it into Creole.

Clinic was hectic and patient care was underway. We performed a thorasentesis on a 15 year old who had some difficulty breathing. Labs were still not back yet, even after three days. All the Istat cartridges have expired and no one knows where they are. Invasive procedures are the go-to here. It doesn’t cost much and it helps briefly. They believe the patient has some sort of nephrotic syndrome; her left hand is very swollen and she is third spacing a lot of fluid. She has been here since Monday, in the ICU.

The team split up – some stayed and worked in the clinic while two of us went with Conan. He is Father Rick’s partner. We were introduced to the two chiefs of all of St. Luke’s, which includes 39 schools, multiple hospitals and clinics, factories, orphanages etc. These two Chiefs were found by Father Rick. He literally found them, in a field, behind a dumpster. The kids were raised in the orphanage and began working with St. Luke’s after their schooling. They are young guys responsible for a multi-million dollar operation.

We visited with the Medical Director for the hospitals. He is our primary contact and we work together ber email to facilitate the training plans that will best suit the needs of the staff at the hospital. He is a smart clinician and recognizes the need for better team dynamics and the use of evidence-based medicine in the physician decision-making process.

Conan brought us there to look at the ambulances. All of the trucks that are being donated from foreign countries last only a day or two on these Port-Au-Prince roads before they break down. The trucks are too expensive to fix or they don’t have the parts here, and the hospitals are not able to safely transport patients.  They have six Toyota SUV’s that look like Land Rovers; they look like they are designed to handle the terrain here. We were asked about refitting these ambulances and creating a way to secure oxygen and stretchers. We brainstormed for quite some time and we think the traditional ambulance set up will not work and will not be safe.

We saw the banana plantation, another micro-economy, and headed back to the hospital. It was hot today. Heat index registered 120, the actual temp was only 100 degrees though.

Solange and Jenna left on Thursday. We were down to 4 team members. Nicole’s family lives in the PAP area and we were invited to her home for some home-cooked food. We traveled on roads that were barely the width of the car, yet were two-way streets. There was no paving and the 4-mile trip took 75 minutes.

They have a rush hour here, similar to Boston’s. There is traffic from 7 in the morning until 8 at night. The Tap-Taps, which are the public transportation vehicles, overwhelm the roads and carry 20-25 people, which is very tight and cramped as there are only eight seats inside!

We drove over a dried-out canyon that was previously a river, and finally made our way to our hostess’ home. She dialed a number on her Blackberry and the gate opened. It blended in from the outside, but once the gate opened; there were palm trees and a landscaped yard. In the nice areas, the homes are big and flat here.

We ate outside, a dinner prepared by the help. We only caught every other word of the conversation as we were loosely translating from Creole to French to English. We met with an internist who studied only in Haiti and explained that after college you go to med school for 6 or 7 years. If you want a specialty, you go to “the states”. She didn’t speak English but understood it. She spoke back to us in French.  There was a little girl, Nicole’s niece, who was climbing on us and braiding our hair. She had greeted us when they dropped off Nicole at the Villa on Monday. She kissed us all on the check and hugged us. She said she “had manners.”

The children in Haiti are much better-mannered than most you see in the US. When we dropped off the books and toys at the orphanage, they took them graciously and shared with each other. The sense of value is different here. The life lessons learned on these trips are more than valuable. They can change you as a person; change what you think is important.

 

Posted in 2014 February, Clinical Experience, Culture, Haiti, St. Luke's Hospital, Training

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