First "Kill"

I've heard from soldiers that you always remember your first kill. Today, mine came in the form of a Haitian housefly with the electric flyswatter. See picture below. We operated today, and a window was left open in the operating breakroom without a screen, so with all the doors that are left open and even when closed, don't seal tightly, we had FLIES and MOSQUITOS GALORE in the ORs today! We are all quickly becoming proficient with the electric fly swatter which resembles a tennis raquet. We all have double duty as health professionals and fly killers. The zap of the bug killer is music to our ears!

It is Sunday, and supposed to be a light day as most locals are in church. Since we celebrated Sabbath yesterday, the traditional Jewish and Adventist day of rest, we worked today. Our teams got some GREAT stuff done in the OR suites. The sterile processing room was doubling as a dirty instrument processing room. Not a good idea to have clean and dirty instruments in the same room for obvious reasons. So, a group of nurses and staff cleaned out a huge scrub sink of instruments and sorted them, then the facilities men moved the sink into another room that was emptied and cleaned top to bottom, and now they are working on moving all the supplies back. HUGE project. Having done a major organization project in the DR last May, I understand the overwhelming feeling when getting started, and its amazing to see such a big job accomplished. It will make a huge difference for instrument processing and huge leap forward for cleanliness and disease transmission.

From the Ortho standpoint, we did three cases today. Our first case was an 18 year old woman with an open tibia fracture who now has an external fixator on her tibia. Her bone is infected and we needed to clean out the bone, cut the bone ends off to get down to clean healthy bone, and reduce the bone back into alignment and tighten up the fixator. After that case, we cleaned out a few other open wounds with infection and pus. In between, we helped to sort screws and instruments. It seems like any trip Jeannie and I are on, we end up sorting screws together! It's just one of those jobs....

We did enjoy dinner out last night. We went to the hotel down the road a ways via Tap-Tap hired by the hospital. The service is notoriously slow, so we enjoyed a night out in a nice atmosphere and just visiting together. The hotel had a nice 2nd floor open veranda with large fans running, so there was a nice cool breeze. It took about 2 hours to get our two cheese pizzas (probably had to age the mozzarella first) but it was pretty good and certainly edible. I was so tired by the end of the night, I was seeing double almost. The hospital sent an ambulance to pick us up and take us back to the grounds. It was a good night out.

Before our first case today, I tagged along as Terry and Scott walked through town up to the "heliport" to greet an incoming helicopter from Santo Domingo with a friend of his on board coming to help and deliver some supplies. It was great to walk a bit through the streets, see some people, meet some children and catch a few pictures. The children are friendly and often want to have their picture taken and see their picture on the screen on camera. One boy, probably 10 or 12 years old kept saying, "Hey you, hey you" so we would try to exchange a few phrases. One of the first things he asked was if I had any money. I was carrying a shoulder bag that had some supplies from the hospital in it and he kept wanting some of what was in the bag, even after I explained it was hospital supplies. Even patients' family members may ask for money after greeting and smiling at them. It is hard to say no, but there is more need here than we can ever meet. There was some rebuilding going on of a wall along the road with new ditches and supports going up. There are many street-side stands selling all sorts of goods from clothes to toiletries and everything in between. One has to remember that pedestrians do not have the right away in this country and to get out of the way of the motorbikes, tap taps, and other vehicles driving through the streets.

Today, we did get some hot lunch. I'm not really sure what it was, I think some tofu (though Terry now clarifies that he thinks it was gluten) in some sort of sauce, a vegetable, and some rice with some sort of cheesy tasting potatoes (I think they were potatoes). The rice and cheesy potatoes were very tasty and so was the gluten. It was certainly food and filled my belly which was good. Dinner tonight will be more power bars and trail mix, which is good too.

Tomorrow will be an extremely busy day. Manic Monday, so i'm told, and the guards will have to hold the crowd back at the gate. We will have a full day of clinic and some surgery. At this time, it's a lot of washing of infected wounds and while we could do some "clean" cases of non infected extremities, we are just trying to help a lot of infections so they can hopefully heal. It's hard to see the pain and suffering these people are and have endured with their injuries, but the alternative would be that they would all have amputations and live a very crippled life. There is some amazing work being done here and helping so many people. There are still great needs for the people here, one of which is training for the local hospital staff-- things as simple it seems sometimes as keeping doors shut to keep the flies out of the ORs.

Another interesting occurrence for me today: a large group of volunteers came last night as part of the Cure International group. Today, there was a physician in one of the ORs whose name was familiar to me. I was trying to place him when I realized who he was. I asked him where he was from and he confirmed my suspicion that he was in fact from Philadelphia and was one of the Emergency Medicine physicians who lectured to my PA class back in January of 2001. We chatted for a few minutes and when he saw me operating the electric fly swatter, he was very proud of his teaching back in the day. Apparently he still lectures at my alma mater in Philly.

Tomorrow will be another test for us all as the local staff comes back in full force and as we learn to work together more and struggle with the language barrier. Scott brought one of his scrub techs with him to help for a few weeks from the DR, so we have been speaking Spanish, a few words in French, and also of course English. My french lessons have come in handy a little bit so far and I have actually taught a few words to people throughout the days. I need to refresh even more with some phrases and vocabulary. I have also asked the translators a few words as well. I do find myself thinking in Spanish more since that is my foreign language of familiarity. The language barrier is hard and frustrates us all at times. There is a translator staff to help-- locals who started as volunteers and then were hired on by the hospital a few weeks after the quake when they said they needed to get to productive work and making money. Their English knowledge varies but they are a great asset to medical care for these people.

Well, I am going to get some pictures posted here hopefully (when the internet is back working again) and hopefully get some rest tonight. I for one am hoping for a quieter night tonight than it was last night so I can get some better sleep before 11. Pictures to follow another time: