Some more thoughts – Friday, January 29, 2010.
I don’t think I wrote much about my first impression upon entry into the Hinche hospital last Sunday. It was really beyond belief for us – even after visiting the hospital in Peru. The large room full of beds, a ward, was full of patients, many of whom had legs attached to a rope and plastic bottle full of sand acting as their traction device. In the US, we have 5 lb weights. They are attached by a plaster cast to the foot here, and this tends to irritate the skin.
In the US this traction is usually overnight, with surgery scheduled the following AM. Here most will be in traction for 6+ wks, until their fracture stabilizes. They did not have the rods necessary for fracture stabilization, nor the sterile conditions to make such repair feasible. Unfortunately this also exposes the patients to a very high rate of pulmonary embolization. One patient actually did suffer such an occurrence with threat to his life later that night. Fortunately, he received emergent Rx from the Americans and has survived.
The rooms are dark. During the day, they are poorly lit. And at night, there is usually only one small fluorescent bulb lighting the whole ward.
Patients receive their primary nursing care from their family, who attend to them at the bedside constantly. They feed them, clean them, clothe them. The family brings in their food. There are buckets at the bedside for toileting, and the family empties them. I’m afraid to inquire where, but saw one just dumping the contents in the hospital courtyard!
There are only a few windows, and of course no screens. Therefore, the patients are covered with flies! Their wounds are so covered as well. The family, when attentive, brushes the flies away.
I couldn’t comfortably take any photos in there. As a physician the patients look at me hopefully, and the last thing I could do would be to take out a camera and memorialize their misery. Some of them had compound fractures, with the bone tearing through their skin. These do require surgery, and it should be done urgently. As I have said earlier, their surgery is unnecessarily delayed. In one instance this resulted in the patient become septic. She went to emergency surgery by our team and had her left leg amputated, and her right one sliced open for drainage. She did survive and our team was able to further debride her wounds before their departure.
In one corner of the pediatric ward, there was a child with 40 burns. He was crying and he had a crowd of people around him. At first I thought they were chanting, then realized they were praying and signing. This occurred frequently around patients in the hospital.
Another child was in traction – he had broken both hips. He lost his family with the exception of his grandmother in Hinche. Before they left, our team was able to place him in a spica cast. There was another child, with broken hip, who are required and received a spica cast from our team.
One poor fellow was crushed in the quake, and had his spine severed around T10. He is a quadriplegic. I heard today, the one of the hospital ships had offered to take him. But the hospital administrator denied this request. I don’t know what they will do with him.
The country is going to be in great need for prosthetics, crutches, walkers and wheelchairs. I have previously told you, the only survivors among those injured, were with limb fractures. Anything more serious resulted in a quick death.
Amongst the trauma victims are a large patient component of incredibly bad disease which usually populate the hospital. It seems that many patients are anemic with Hemoglobins in the range of 8. Normal is greater than 12. One woman’s was 3.7. She was given two units of blood, but the one was wasted by poor nursing attention.
The patients often had IV’s as at home, but often they are empty, not running, and/or infiltrated. Their urinary catheter bags are usually lying on the bedside. The correct location is hanging from the bedrail below the patient.
The three operating rooms or course also have flies. They and well and the rest of the hospital communicate with the outside. And they have outside window, although they were closed. With the exception of the OR, the hospital has old wooden floors, which of course are hard to keep clean, and perhaps impossible to sterilize.
As I walked through these wards day to day, the patients would watch and look at you hopefully and expectantly. I felt bad that I was not necessarily going to their bed, and especially bad that I couldn’t talk to them.
I will be interested to see what the world press is reporting about this catastrophe. Certainly I now have an appreciation regarding the difficulty and lack of efficiency in the world response.
John
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