Thursday, February 22, 2007

Britt's Return to the Blogosphere

By Britt:
Well, there have been several complaints about my lack of posting on the blog. I'm sure that some of you (probably most) have enjoyed the lack of gory pictures; but I aim to please. I finally have some material worth posting. On my computer, I have a folder for each month's medical-related photos. A 'January' folder doesn't even exist - that proves how slow things have been over the last month and a half. Looking through my medical log ... the most interesting cases have been:
Our first grade teacher, Franchesca, brushed by a school desk and got a long, deep splinter. I had to 'surgically' remove it because it was inaccessible from the surface. I did this by removing a small almond-shaped piece of skin in order to reach the splinter. It was about two inches long. I stitched it up afterwards and it has long since healed. (no photos, sorry. Or maybe you're welcome. ;)
Quite a few toenails have fallen off (of various kids and adults.) Causes include: moto accident, falling in a soccer game, and thrown rocks. I've never had my toenail fall off, but it is apparently very painful. I am led to believe this by the way that missing-toenail patients behave during dressing changes.
On January 21st, I stitched a three year olds forehead. He got cut while carrying a bucket on his head. It was a fairly small cut and only took about a week to heal. He was very cute and sweet; I will have to track him down and take a picture of him sometime.
On February 8th, a man named Joseph came with a cut thumb. It happened the day before; he had been working, cutting branches with his machete. He was very fortunate; the cut almost severed the entire tip of his thumb. I was afraid that the bone was exposed and that thumb would need to be amputated back to the joint. After a successful digital block to numb the thumb, I checked and didn't find/feel the bone. Because it was far more than 12-15 hours after the accident (and therefore couldn't be sutured), I used steri-strips to hold the edges of the cut together. It took about a week to heal.
On February 11th, a very upset eight year old boy named Rod came with a small cut above his lip. He and his older sister had gotten into an argument (or were play-fighting, who knows), in which she punched him ... and hard too. He was very afraid - I knew I was in for it when he started screaming "Pa koud li! Pa koud li! Pa touche'm!" (Don't stitch it! don't stitch it! Don't touch me!) before we ever started. Luckily I had Paige's assistance in calming him down. Rod definitely tested my Creole reasoning skills. (Wi, cheri, si nou bo ou piki, ou pa ap santi anyen - li bon pou ou, fe konfyans'm. Yes, darling, if we give you a shot, you won't feel anything - it's good for you, trust me. And on and on. :) The fact that he could see everything that I was doing was more difficult too. But four stitches later and he was as good as new. The whole sibling thing bummed me out but then again, I did once run over Paige (specifically her nose) with a bike in a game of chicken. :D
To the Michigan team: Chasverli, the two year old girl's abscess healed up very well. It closed up completely yesterday.
On February 18th, a man named Aysif came, already bandaged. This is one of the things I dread the most .... because usually if it has already been bandaged, it is too late to do stitches and usually requires cleaning up after somebody else's less-than-satisfactory work. I'm not conclusively bashing Haitian health-care, but I have yet to see a wound sutured properly/effectively in this area. And again, there is that short window-of-opportunity after the accident occurs to get it sutured. This man was hit by a motorcycle, or more-like fell when a motorcycle brushed by him too quickly. I feel for him, I can't count the number of times we've almost been hit while running. Anyway, he'd gone somewhere in Archaie for stitches for the small cuts next to his eye and on his scalp. I removed the stitches because the scalp cut was infected and the thread in the eye was falling out on its own anyway. He is doing alright, both cuts are close-to healed. Today I gave him a tube of triple antibiotic ointment and some bandaids for him to finish the job. As I was handing him his dressing supplies, I noticed this:

This picture does it no justice. This is a broken bone that was never set/casted/diagnosed. Surprisingly, he has almost full range of motion. It happened seven years ago when he and his brother were working, cutting wood with machetes. They must have been working side-by-side, because his brother missed the wood and came down on Ayisf's thumb. He said he got it stitched at a hospital in St. Marc but that they weren't too concerned with the bone. I believe him.

This afternoon, a 21 year old named Krisnel came. He too came, already bandaged, and looking for follow-up care for his wrist laceration. The accident happened last night around 7pm. He fell and landed on un kout (small-version of a machete) that was lying on the ground. He arrived here around 3:30 ... so that clearly is past the 12-15 hour window that I usually go by for suture patients. Maybe it wasn't the right thing to do, but I decided to give it a try. I explained to him the risk that his body might reject the stitches because it had been close to twenty-four hours since the accident. He understood and agreed that it was worth a try. It looked much better after I jet-washed it out, but this is the before:

They hadn't put anything on the wound, just wrapped it in gauze and tape. I've never stitched a cut this late after it happened, but it was very clean to begin with and I just felt that this one could handle it. I also have heard that the window of opportunity is more like 24 hours. Maybe in America, but I've rarely seen that rule of thumb apply here. It will be interesting to see when he comes tomorrow for a bandage change. I don't want to call it an experiment, but I am anxious to see how his body handles it. If it rejects the stitches, then we'll just remove them and use steri-strips to hold it together while it heals.

The Stats:

Although this year has started out fairly slow,

  • As of January 1st, 2007, I've seen 70 patients. (This is counting individuals, not return-visits/patients-per-day.)
  • 4 of these have been for stitches
  • About 25% of visits were because of a machete-inflicted wound
  • 50% of visits, cuts and burns, were the result of bad motorcycle driving
  • 10% = scabies, heat/diaper rashes
  • The remaining 15% is miscellaneous: ear infections, minor abrasions, a few new fatty cysts, and a new tropical ulcer.

The only other thing I can think of to tell you is that baby Lovely is doing very well, she is up to 13 pounds. I know that doesn't seem like a lot, but she is still getting formula and doesn't look skinny at all. She seems to be getting longer twice as fast as wider; we think she is going to be a very tall girl.

I am still seeing Krispe every-other-day; he is alright. I realized the other day that I really love him, that changing his bandage is not burdensome at all and that I worry about him when he doesn't show up. I regret ever feeling that the five minutes of work every other day was a pain. I'm human, and non-responsive wound-care can be a real downer, but I'm glad I realized my mistake. His ulcer remains the same; with the meticulous bandage changes, we've been able to keep it infection-free but have not seen any improvement/shrinkage in its size.

Thanks for listening to me ramble off random medical stories. And for those who are fans of the blood and gore, realize that if I had more pictures - I would so post them. :)