Wednesday, May 12, 2010

Halfway Through Deployment

Dr. Mark Courtney is from Northwestern University and is representing the Chicago Medical response team with International Medical Corps in Haiti. We'll be posting his updates from the field over the next week.

At this point I am halfway through our deployment.

I have seen a rapid transformation of the emergency department in a short period of time. Right before we arrived they had recently just moved all ED operations out of the tents and inside. That being said, in many ways it is not at all like an ED that you could imagine. To reiterate, we have no X-ray, no CT scan, no air conditioning, no flushing toilet, no running water even. We are using gel hand wash between patients. At one point while working in the ICU, I successfully discharged a patient with congestive heart failure (a major achievement) and the family started unplugging all these fans that were around her. I was a bit upset and not sure what to do about them stealing what to us was a precious commodity until I relized that all the fans in there were belonging of the patients and their families that they brought in.

All our oxygen comes from standing huge oxygen tanks that have to be rolled slowly and carefully around from patient to patient. During one ICU shift, we had to scramble to jerry rig some splicing and tubing to get 5 patients oxygen that normally would be allocated to one. There are no monitors to continuously monitor patients (well that is not true -- there is one but only one and saved for the sickest patient). We transfer patients to "the medicine ward" which is a frightening place with billions of sick patients packed in with near darkness and often no nurses or doctors to see them for days at a time. Honestly it is better to send people back to their home or tent even with severe illness than to the medicine wards which are at times affectionately termed “the catacombs”.

Still in many ways our ED has rapidly evolved to look exactly like an ED back home. This is amazing since there is no history of emergency medicine or even an "ER" in Port-au-Prince. True, they had a pre-existing "urgent" department but this was not in any way staffed 24 hours a day with an emergency specialist. Just 3-4 weeks ago they still were seeing ED patients in adjacent tents. So it is surprising to now see people coming to our ED with things like chronic pain, anxiety, sickle cell disease, hoping to get surgery for a long standing problems or at least a second opinion. These problems in the US are common ED presentations but are best dealt with in other departments.

It is also not uncommon to get "transfers" from other hospitals or clinics without much regard for our capacity or environment. Some other medical NGO's will not send us patients in an ambulance with a note in French stating need to be admitted for surgery or oncology care without any understanding that at the time our surgeons happened to be on strike (well not sure you can say they are on strike since they have not been paid for months many not since the earthquake. Is that called being on strike or is it just not having a job?). Anyway this movement of patients from hospital to hospital is a totally a common occurrence in the US and it is amazing to me that our ED and the overall health care delivery system has some of the same problems we see in the US. The good things are that we can transfer patients to higher level of care for some things, for example women who need a C-section. I recently got a patient of mine with burns over 50% of her body transferred to a hospital that specializes in burns.

Anyway, things here are progressing -- most would agree that the state of emergency health care here has never been better (at least for the poor in urban Port-au-Prince). The challenge is how to maintain it in a sustainable, local manner.

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