Petit Goave - wild and rewarding

Ravi, Aileen and I didn't have much time at Petit Goave, but certainly got a true sense of the kind of wild medical needs there.

This was an outdoor clinic, whose layout changed as the needs and the staffing evolved - 400 patients per day, obstetrics, pediatrics, trauma, infectious disease and a collection of primary care problems were all part of the mix.

Our first day was incredibly intense, with penetrating chest trauma, cerebral malaria in a 12 month old, sepsis in a 1 month old, and an ampuation on an elderly woman who had fractured her arm in the earthquake and only now had come in to be seen. I did one chest tube, one interosseus needle, multiple IVs, and diagnosed my first (but not my last) cases of malaria and typhoid. This was part of my share of the 300 patients seen that day.

My very first patient seen in Haiti was the 14 year old girl with penetrating chest trauma; I had just finished unpacking and a nurse ran over and asked for "any doc to the ICU". Welcome to Petit Goave. The 'ICU' was a stretcher placed under a tree, just out of the drop zone of the coconuts expectantly hanging over us. The girl had been smashed in the head with a rock, then had been stabbed in the chest by a long thin spike. She had sustained not only penetrating chest trauma, but it looked like her liver had been damaged as well and we thought she was bleeding in the abdomen. The decision was made to transfer her, as we really couldn't do a laparotomy here. As the 2 hour transfer would take place in an old pickup truck with no medical supplies driven by someone with no medical training, we would send along Gavin, the surgical resident from Dalhousie. We decided to place a chest tube before transfer, which I managed to do with the basic supplies at hand - this resulted in the pnuemothorax slightly worsening, until we could replace the home-made Heimlich valve with a waterseal unit that Michael managed to dig up from somewhere. Kudos to him as usual.

The team there was incredible. Aside from our group from the maritimes, there was a group of Portland, Oregan firefighters who were awesome - skilled, hard working and very accomodating. There was an internist with extra training in Chinese nedicine, a naturopath, a psychiatric nurse, and a 4th year emergency resident. We really enjoyed working with hthese folks, and we all benefited from each others' skills; Maureen (the naturopathic doc) did her first ever delivery with the teaching of SueLin, the ER resident, and Mike and I got to teach a little about airways, and anaesthetic drugs, and interosseus access.

I'll post a little more about the medicine, and try to get a few photos up as well.

Colm