Disaster response B #2
I made it to the disaster area hospital today. At 9AM we took the Caravan plane to the other island that was more effected by the hurricane where the emergency tent hospital was set up. As soon as we land and unload our stuffff into a mobile cart- it downpours!!! We head for the one tent that is the only shelter. There are so many people waiting under it that our stuff sits out in the downpour fo r 30 minutes till it passes. All my cloths are wet, but I had my electronics with me, so they are OK. Samaritans Purse has a very nice set up, with tents that make up a full 40 bed hospital. Generators run non-stop, large oxygen concentrators are hissing, a container with a huge water tank on top gravity feeds all the running water. A tent with cots for the men staff, and another for the women. A male ward, female ward, OB ward, a connected tent that has ER, ICU, step-down, and OR all under one connected roof of 4 tents. The equipment is state of the art, monitors, suction, anesthesia machine, surgical packs, gauze, medicine, ultrasound machine, mobile x-ray machine. A mess tent. Tarp lined showers, porta-pottys. I found a cot that appeared mostly empty and put my stuff down. The tent is air-conditioned, and that will help with sleeping! Amazing. The wards are not, the OR is. After lying down my stuff, I headed into the hospital to find someone who knew what I was to do. I found the clinical coordinator and she showed me all around the hospital, and introduced me to the staff. We have 1 OB/GYN, 3 FP docs, me, and 4 ER docs. The local RAND hospital is right across the street. But most things were destroyed in it, when the whole island sat under about 4 feet of water for 2 days. In fact the first 4 feet of any metal building was destroyed, leaving higher walls, and a roof intact on some. Trash is piles out of all the houses. Anything that sits less than 4 feet in a house was destroyed! Imagine how little is left in the homes that are standing? There is gradually local power coming back, no water yet. Power lines lay across the road in places on our way in.
After being shown around the hospital, I was asked to see a few patients with one doctor. On the male ward and female wards- there are many people who are overweight, have diabetes, and walked around in the 4 feet of water for 2 days. This has led to many of them having cellulites with I’m sure a variety of bacteria. I evaluate a guy with a bowel obstruction and another couple patients. Then there is not much to do but wait. Right before supper I’m asked to see another patient.
This guy was found unconscious yesterday and brought in. A white blood cell count shows 7 yesterday and 23 today. Very high. I touch is abdomen and he winces in pain. I let go and he is much worse. He has peritonitis. A slew of labs were ordered yesterday, but the RAND hospital across the road isn’t able to get them to us quickly so we have very little. No liver numbers, no pancreas numbers, only a few electrolytes. So I decide he needs to be explored.
Supper tonight is a lot of beef with a little broccoli and potatoes. So I pick out the broccoli and potatoes and eat that. (I’m a vegetarian). After supper I ask where the family is, and no one has seen them, and he apparently was living alone. I ask whether I should go ahead? They decided we should contact the RAND hospital and see if they had a way of finding out. About an hour and a half later, the medical director from over there, comes and evaluates the patient with me, and he agrees with the need for exploration.
We head to the OR. After the anesthesiologist puts him to sleep, I open along the mid line. I encounter what appears to be cloudy fluid. I find the appendix- normal. I search the large bowel for diverticulitis- normal. I look at all the small bowel- normal. I look at the stomach front and back- normal. I mobilize the duodenum- normal, but the pancreas is inflamed! Pancreatitis! So we close him back up and he goes back to the step-down unit.
I take a shower under the stars- and now think I’ve wound down enough to finally ready to sleep.
Greg