Haitians are incredibly strong

This morning we accompanied the Doctors and Physical Therapy Staff as they made patient rounds on the wards with the Surgery and Medicine patients.  As we did so, I am always struck by how incredibly strong the Haitian patients are compared to many of us in America.  WARNING:  IF YOU ARE NOT A HEALTH CARE PROFESSIONAL YOU MAY WANT TO STOP READNG NOW.  The descriptions are somewhat graphic and are intended to resonate with my medical friends—so much the same and so much different.  I watched as a surgeon pulled the bandages off a patient with an open colostomy put in place after discovering a tumor in her abdomen during surgery.  The bandages had been “compromised” and I won’t describe the condition of her sheets.  These will be washed later by her family in the courtyard outside the hospital using cold water and scrubbing them by hand with soap; patients bring their own sheets.  With the bandages off, the surgeon proceeded to sit her up on the side of the shaky rolling cart that served as her bed.  He then removed the tape from her nose and pulled out her NG tube.  I’m not sure why; perhaps to visually check if it was clear.  A few minutes later, he inserted it back into her nose again and taped it down.  After we left, her family came back and it looked like they were going to gather up the sheets.  I can only hope.  One bed over, another surgeon was using a razor blade to debride an ulcer over the trochanter.  He said the tissue was too necrotic to be sensate and this must have been true, as she didn’t flinch.  We looked at an open wound post guillotine AKA; it will need further surgery.  The Haitian Physical Therapist argued for going ahead with a hip disarticulation, as the residual limb would be so short that fitting a prosthesis would be almost impossible.  Given that the other limb is cool to the touch, ambulation for the patient is probably unlikely so he may be better off with a short femur to help with sitting balance.  However, leaving a short femur may lead to a wound that won’t heal, eventually necessitating a hip disartic, so it may be best to limit the number of potential surgeries from the start.  Familiar but terrible decisions to have to make.   Finally we saw a patient in kidney failure.  Dialysis is only available in Port au Prince (and maybe a couple of other places, but not here) and the cost is far, far beyond what most Haitians can afford.  So I asked one of the visiting young MDs if many Haitian patients lived to Stage IV kidney failure where dialysis is the only way to survive or if they succumbed in stage II or III.  She said that a few younger patients with no other complications did live briefly in stage IV.  Those with cardiac or other problems do not.  So much the same, especially with our unfunded patients at Parkland; so much different.