6 Steps Towards the Skinny Cow

We finally made progress. About 350 patients started lining up this morning at 0400. They have a number system here to decide how many patients are seen. Chief complaint determines whether a person is seen by a doctor or not. The patients are smart enough to lie. They know how to beat the system. How can we be useful?

We took the standard triage criteria and began assessing the patients. The RN recorded the info and talked briefly with each patient. We rapidly assessed vitals – pulse, respiratory rate, blood pressure, and O2 saturation. We then allocated the appropriate resources and space to the sicker patients. The patients were triaged in 2 hours, less than the usual time. Success #1. Good job to Brittany, Mike, Jeremy and Reneau.

Carl worked with a Haitian doctor today in the clinic. The doctor practices in America now but comes back often to volunteer and see patients in the clinic. Today they saw about 55 patients, 30 in the morning session. Younger patients left with remedies and hope. Success #2.

Vahe and James focused on equipment and how it affects patient care. They worked for two days to resource the correct parts and to fix the equipment. When they fixed the i-STAT, Vahe and James were able to perform a chemistry panel with hemoglobin and hematocrit. 78-year-old male presented with a GCS of 3, febrile, tachycardic, with bilateral crackles in the bases. Presented initially to the cholera clinic with a history of possible cardiomyopathy. The ability to process the patient’s lab values determined that one of his main issues was severe dehydration, resulting in the appropriate treatment. This determination was made about 16 hours earlier than it would have been if traditional labs were ordered. The hospital also made the decision to withhold diuresis until after the patient was fluid-resuscitated, which was ultimately the correct treatment course. Haiti has a huge prevalence of patients with undifferentiated altered mental status and anemia. The ability to run these labs values and obtain results within minutes rather than 1-2 days, can help the hospital promptly diagnose, set, meet and monitor treatment goals. The hospital remains short on these supplies and currently only has 5-7 days worth of testing capability. We are looking to resource these cartridges. Success #3.

Brittany and Mike spent the afternoon at St. Damien’s hospital assessing very sick pediatric patients, 2-lb twins. We thank the medical director and her staff for the opportunity. Success #4.

Reneau, Jeremy and Carl taught a vitals assessment class today to 13 participants, including techs and cleaning staff. They were taught to assess mental status, pulse, respiratory rate, etc. The vital sign clinic was exceptionally well received today. One of the staff would like to become an EMT. We will train him and he will train others. Success #5.

Jeremy advocated for a patient today. A gentleman presented with a unique case. An approximately 8-lb hydro seal complicated by an infection that he couldn’t control. After 90 minutes working with JJ, an amazing tech at St. Luke’s, they convinced the doctor to revisit the patient’s case. The patient used his crutches to get back to the emergency room area. We examined him and found multiple infected sites from heat and friction. His left leg was much smaller than the right. He had been bounced back and forth between multiple hospitals with no help. No one would give him antibiotics until he had his leg (another infection surely down to the bone) operated on, and no one would operate on his leg until his infection was healed. We helped the doctor treat and bandage the wounds. The doctor agreed that he would X-ray the leg and if an orthopedic surgeon was not needed, he would give the patient pain meds and antibiotics. Jeremy escorted the patient to X-ray. This patient could not be helped by us; the X-ray revealed cancer all through his left femur. We felt very defeated.

We walked back to our home away from home, Villa Fransesca, and spoke of JJ. He interpreted, triaged, organized, was our “go-to guy.” He survived so many things. He seemed defeated. We would need to prevail, for the other patients who could be saved.

Team METI: 5.
Situation in Haiti: 1.

Here, the cows we pass on the road while walking back at day’s end, are very skinny. Skinny cows.

Posted in 2013 April, Clinical Experience, Haiti, Patient Stories, Training

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