The thing you first notice about the Haitian doctors is their focus. Being accustomed to innovating and relying on their clinical and assessment skills without the aid of many diagnostic devices (i.e. sonography, CT scan) has made their attention to detail and differentials very sharp! Sharp in ways that many of us in the US have tuned out or never learned, due to our reliance on telemetry and people to interpret readings for us. So we taught each other our strengths. Was remarkable to be around people who could teach as easily as they could learn.
During our stay, we started offering training to the translators who worked at the hospital. Very smart group of guys, none were medical to my knowledge; circumstance had put them in their jobs. However, when we started showing them some basics skills - how to place EKG leads, anatomy via scan, sterile technique - we found that not only were they quick studies, they had natural intuition, were excited about it and were almost immediately good at everything we showed them!
Junior teaching what he learned back to Rais.
CJ showing the team how to scan the IVC diameter and evaluate hydration status. Before bi-pap, his IVC was nearly collapsed and changed less than 10%. After about 10 minutes of bi-pap, diameter was fluctuating about 30% on inhalation and sats rose from 82 to low-mid 90's!
We had quite a few very sick patients who presented late in their disease, with little or no previous medical care. So, we pooled our resources and combined everyone's experience to give the patients the best possible shot available to them with the resources on hand. Was nice to see an entire team of people concerned with the patient outcome over the "I know more than you" game.
This kid Claude was asking all kinds of very intelligent questions about O2, anatomy, disease process, etc. as well as translating to the family of the patient (lady on right).
CJ was scanning the patients heart and Claude - who is 17 - walks over, points to the monitor, and says "His left ventricle is too big." Which it WAS due to the patients CHF. I told him he definitely needs to look into medical school!
Dr. Spindi looks on as we rig together a bi-pap with materials found in the ED. O2 tubing, old vent machine, cut a hole into a BVM and used a glove finger to make a one-way valve, kurlex, tape. I handled the airway while Rais made the mask and CJ titrated the mini-vent machine (which had been buried in a box, unused for a very long time).
The patient should really have been intubated, but the issue came up, "what do we do with him when he's tubed?" No real functioning ventilators, no ICU, no RT, no one to watch the patient, no facility to transfer him to...So we converted the ER that night into an ad hoc ICU and did the best we could.
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It took us a while to make sure everything was in place, figure it out, test it, and make sure it was going to maintain. The patients family just had a confused look on their faces, as we were working, and trying to explain what we were doing, why, etc. OH and p.s. - the patient was suspected of having TB. Score!
Alot of what I know I owe to Scott and Jen of the SFFD and John Cavanaugh (also of SFFD) and Megan Corry of City College of SF. Here's the proof; we used ABC and it worked. We were able to keep the patients O2 sats high, keep him comfortable, manage his fluids...
Large hose of a BVM/neb, non-rebreather mask, a nasal cannula, a glove finger, sonography gel (one thousand and TWO uses!), kurlex, and tape. Put them together... home-made BI-PAP!!
Using patient's shirt to position the head...
At the end of the day - if this man had a chance - we gave him that chance, against considerable odds. Was it pretty? No. Functional? Yes. This is what is going on in Haiti right now - making the most of what's around and throwing the best available shot at dire illness.
Gracious Savagery.
