Friday, February 19, 2010
Some Milot Facts of Life
First, I found out that I'm the only emergency medicine guy on the team going to Milot. Seeing my name on the list was a bit of a thrill. I guess I'm getting too cynical, but it didn't seem real until I saw it in print.
So I got a little additional thrill this morning. Then I read the rest of the email. A frequently asked questions (FAQ) attached to it was pretty sobering.
The good news: I can take one change of clothes with me. The rest of the time I'll be in hospital provided scrubs. This is going to be the first time I've been practicing medicine in the field, in scrubs! Hot showers are available. Also pretty nice.
Unfortunately, that's the good news.
There are specific warnings about tetanus. They've already had patients succumb to tetanus. There are docs in the US who will never see a case of tetanus in their lives. It's a vaccine we (should) all get as children, and updated as a matter of course every 5 to 10 years. The Haitians may survive being crushed under a building, only to die from a completely preventable disease. It's chilling.
We're advised to make sure we eat, and get 5-6 hours of sleep a night. This is going to be good practice for medical school and residency!
The hospital has a 6-8 bed ICU. Ventilators will probably be available by the time I get there. Once again, something that we take for granted in the US, simply doesn't exist down there. In the US, if you need a vent, we get you one. If this hospital doesn't have one, they'll rent one, or transport you to a hospital that does.
Think about all those hospital TV dramas you watch. The ones where the hero (or mom, or dad, the son or daughter) is hooked up to the scary looking machines, while the loved one holds their hand, and tells them to come back. We won't get to that scene, in this drama. The realities will end the show (the season, the show) much earlier.
This is also a safety net that just isn't there. Miss something early on, and you won't have the option of intubating the patient, and supporting their breathing until they heal enough to breathe on their own. You have to stay completely on the ball, and not miss anything.
This is made all the more scary by the numerous times the FAQ says "You need to time manage", or "You need to hurry". Those aren't the exact words, but that is the impression. We're going to be seeing a ton of patients. We're not going to have enough time for the numbers of patients (Do you ever?), but the consequences for missing those subtle, crucial signs, will be dire. I'll be saying that most famous prayer, "Dear God, please don't let me screw up"
The lab sounds better and worse than I expected. Most conventional blood and urine tests will be available. That's good news. Apparently everyone is anemic, so H&H's are getting run continuously. However, no cultures are done at the hospital. None. Something in my mind made me think: If they have a lab, they must be running cultures. Assigning antibiotics to challenging patients is going to be another challenge.
Most patients arrive by helicopter. In the States, this would be a very ominous sign, as typically only the critically ill arrive by helicopter. Now I'm worried that the sick are arriving by the helicopter load (You can fit a literal ton of people into a Blackhawk). However, this is the beautiful thing about emergency medicine: The sick show up, and you start working. You keep going until everyone is taken care of. You'll always have work, and it will always change and surprise you.
The skills of local personnel appear to be highly variable. There are definite cultural, educational, and experiential differences. It sounds like there are problems with night shift workers making sure that patients are getting care throughout the night. IV's are running dry, and clotting off over night. It looks like I may be spending some nights in the ER tent... I haven't done that in a while, but those were good nights too.
Pain medication is in short supply. To top it off, the recommendations are to "Be prepared and willing to give more pain medication than you are accustomed to prescribing". I heard that before in certain operational medicine seminars, but I've never been in a situation where there was such a need, with nothing to give. This is going to be hard, really hard. Our hospitals have tremendous amounts and types of pain medication. Our job is to alleviate suffering. Pain control is so pivotal to medicine, and a patient's perception of their care. I think this is going to be where my limits will be tested. A minute in severe pain is a lifetime to a sufferer.
There are two principal sets of rounds. Morning and night. This is similar to US practices. However, evening rounds may not happen till after midnight, or even 4am. These are some really long days.
Deep Vein Thrombosis is a common complication. For those that aren't big time medical people, I'll run this down. Clotting is a fantastic adaption that we have. If we get a cut, our blood (hopefully) gums up, plugs the hole, and begins the healing process. However, through disease, injury, or loss of homeostatic control, we can develop clots within our body. When these clots form in our veins (typically the large, deep veins in the legs), it's called Deep Vein Thrombosis (DVT). There are a large number of complications that can arise from this, so it is something that we want to prevent. In the US, this is typically done with specific doses of heparin (a blood thinner). In Milot, they're looking at using aspirin. It's quicker to administer, and may be just as effective. Everyone gets assessed for DVT.
Lessons learned, and I haven't even set foot on the island.
I had a nice talk with one of my sponsor's last night. They're working on my travel arrangements. With that taken care of, it makes the deployment even more "Real". I'm hoping they'll let me name names. Too often these quiet benefactors remain in the shadows. I gotta be honest, this trip wouldn't be happening without their support. I'm a poor college student (I'm not starving, but only through the benevolence of others, and occasional honest work), there's no way I could afford to fund this on my own.
I've got to go beg more supplies from businesses. It looks like Casual Adventure is going to be able to get some of our needs (One of greatest local businesses. I really love those guys). I need to hit Home Depot, Microcenter, maybe even Best Buy.
It's going to be a busy day. I'm probably going to take the weekend off from blogging. I'm hoping to get out and see my horse. My girlfriend and I are going to spend the weekend at her place, something we haven't done for a month (though the weekends I've spent at my sister's house have been fantastic), it'll be nice to get away and relax.