Haiti – Day 2: Medical Clinic at Grace Int’l

The Medical Clinic

Though it is only a few miles from the capital, the tent city in Carrefour had been slow to find much relief or assistance –- most of the urgently-needed supplies were used up by the populations and camps closest to the airport where they came in through.

When we arrived at Grace International, Dr. Lyons-Jones and I were given barely enough time to drink some water and wash our faces before we were rushed off to the makeshift medical clinic which had been set up in the 25,000 sq. ft. open-air church. While much of the church’s concrete perimeter had been damaged, the inside sanctuary had been deemed “safe” by relief workers because of its steel beams and aluminum roof, so it was turned into a temporary clinic, with its benches and pews used for supplies and examinations, and its wooden tables used for exam beds and even operating tables –- only a couple days before our arrival, doctors had successfully performed an emergency c-section. Initially, a group of doctors and nurses from Hospitals for Humanity had been manning the clinic, along with a few others who had been sent by other organizations, including Dr. George Poehlman from Ft. Bragg, North Carolina, who has spent many years working in AIDS clinics in sub-Saharan Africa.

Despite the working conditions they faced, the doctors and nurses had been successful in setting up a respectable working clinic. By using the wooden benches in the church sanctuary, they had blocked off a number of “wards” where they would treat patients after they had checked in at the triage desk: “Acute/Critical”, “Chronic”, “OB/GYN”, and “Pharmacy”. For patients who needed beds, a number of wooden palettes and a few mattresses from the orphanage had been set up along the perimeter of the clinic. Otherwise, most procedures were done on a folding table, or right on the cement floor with only a couple of chux laid beneath the patient. Similarly, the triage desk was effective in both keeping account of which patients were in the “waiting room” outside the church, as well as “fast-tracking” any moderate-to-acute patients who came in — much like a US-hospital. While there were always many patients waiting to be seen, it was important to have someone determine if their needs were acute, or if they were there merely to see a foreign doctor, as many had not had any type of medical care in many years. Unfortunately, a significant percentage of the patients did in fact need medical attention.

As Dr. Lyons-Jones went over to the Chronic ward, I made my way to the Acute/Critical Care section where I met a number of young ER doctors from the Chicago area. Once I informed them I was a paramedic, they wasted little time in putting me to work, giving me the nickel-tour of their facilities and their dwindling supplies in the meantime.

The first patient I saw was a woman in her mid-forties who had lost four of her five children in the earthquake. She had suffered what looked like a broken wrist and a broken ulna, but was currently there for a laceration that ran along her left groin. It was probably 8-inches long, 1-inch wide, and 1-inch deep, and looked like someone had simply taken a fork and burrowed out a long strip of flesh from her groin. The woman clearly needed staples to close up the wound, but that wasn’t an option, so I was left to clean out and remove the dead tissue and dirt with hydrogen peroxide, and then put Xeroform guaze and wet-dry dressings over it — a simple procedure which had certainly been repeated thousands of times all over Haiti in the past week. The bigger challenge turned out to be explaining to her and her family that she would need to remain in bed as much as possible, and for a long time, so as to let the wound heal, but moreso to prevent it from getting infected. The family had been very insistent about visiting an “Army doctor,” but I tried to explain to them how difficult it would be for her to get to the Army doctors, and how they were surely dealing with very sick patients already. I also tried to explain to her how if the wound got infected she might end up seeing an Army doctor for much more serious problems, and that she needed to stay in bed, keep the wound clean, and come back to the clinic regularly to get the bandages changed. They told me how she liked to sit in her rocking chair, and they wanted to know if that would be alright, so I had to be very persistent about her staying as still as possible, going so far as to explain to them the need of a bedpan, and even demonstrating it. As I got up to leave they stared at me with suspicious eyes, thinking me foolish for telling them she’d have to stay in bed to use the bathroom.

When I stood up, I saw that the doctors had just laid down a 32-yr old male who looked as though he were 8-months pregnant. “I’m a musician,” he explained to them. “Of course, I drink.” While it was clear that he had had some combination of multiple liver problems, and a wicked drinking habit to boot, the problem at hand was that the ascites buildup in his abdominal cavity had gotten to be so severe that it was now pushing up on his diaphragm and compromising his breathing. While there was no question that he, too, would need more definitive treatment, the best the doctors could do for him right then was to lay him down on a few chux and insert a large-bore IV catheter into the side of his abdomen so that they could at least drain out enough to improve his breathing. Once they had inserted the IV catheter into his abdomen, they placed a small trash bin beside him to collect the drainage, and after about 20 minutes they removed it and shook his hand as he stood up. “I can breathe much better,” he said. “Thank you.” And he walked off, back to the tent city.

There were several other patients I was able to assist with, including a woman who had had a broken left tib-fib that was showing early signs of infection. Using several medications available, we stuck the poor woman with at least three different injections. I then spent the next five minutes injecting another antibiotic direct IV, and the whole time the woman was as confused as could be. “This is the first time she’s seen a doctor since she was a child,” a translator explained to me for her.

From a public health perspective, it was interesting to consider the types of patients we were seeing. Since it was already a week since the earthquake had struck, most of the patients who had suffered injuries resulting directly from the earthquake — including thousands of amputations — had either been treated or were dead, though every now and again a patient from a distant corner of the city would pop up with untreated injuries. Of course, there were untold scores of patients whose wounds had become infected, but now, however, we were seeing more patients with chronic problems, like untreated hypertension and diabetes, as well as several pediatrics who had gotten sick from spending a week in the elements with little water and nourishment. Consequently, the clinic had been running out of the very supplies necessary to treat these problems, and this became particularly worrisome when we got down to our last liter of normal saline. One woman had brought a child in (she didn’t know him or who his parents were, and he hadn’t seen his parents since the earthquake), who was obviously dehydrated. But because we had only one liter of normal saline left, I was asked to give him only a 200cc bolus, and then to disconnect the tubing from the bag and clamp it off in case we would need it for another patient.

That patient took less than 5 minutes to arrive.

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Read More:

Haiti Earthquake Project – Home
Day 1: Travel – San Diego to Haiti
Day 2: Port-au-Prince to Carrefour
Day 2: Grace International Orphanage & Tent City
Day 2: Medical Clinic at Grace Int’l
Day 2: “The Transport from Haiti”
Day 3: Carrefour – Boys’ Home Clinic (updates soon)
Day 4: UN/PROMESS Trip 1; Medical Teams International (updates soon)
Day 5: UN/PROMESS Trip 2 (updates soon)
Day 6: Boys’ Home Clinic: Freelance Relief Workers (updates soon)